Year 2019 / Volume 26 / Number 4

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Cilinical Note

NMDA antagonism in the treatment of cluster headache

Rev. Soc. Esp. Dolor. 2019; 26(4): 247-250 / DOI: 10.20986/resed.2019.3710/2018

María Luz Padilla del Rey, Mercedes Benítez Jiménez, Jean-François Canuel, Clara Díaz-Alejo Marchante


ABSTRACT

Standard treatment for cluster headache consists of abortive treatment with oxygen, triptans, ergot alkaloids and/or topical nasal local anesthetic during acute episodes and preventive treatment such as steroid injections, calcium channel blockers and lithium. Although the exact pathophysiology of cluster headache is not well understood, reduced serum levels of kynurenine metabolites with anti-NMDA (N-methyl-D-aspartate) properties have been demonstrated. Ketamine and magnesium, which both have potent anti-NMDA receptor activity, have been used in multiple refractory pain syndromes. We describe a case of cluster headache that was non-responsive to standard therapy and treated effectively with intravenous infusion of magnesium and ketamine.



RESUMEN

El tratamiento estándar de la cefalea en racimos consiste en un tratamiento abortivo con oxígeno, triptanes, alcaloides ergóticos y/o anestésico local nasal tópico durante los episodios agudos y un tratamiento preventivo, como infiltraciones con esteroides, antagonistas de los canales del calcio y litio. Aunque la fisiopatología exacta de la cefalea en racimos no se conoce bien, se han demostrado niveles reducidos de metabolitos de quinurenina, los cuales gozan de propiedades anti-NMDA (N-metil-D-aspartato). La ketamina y el magnesio, que tienen una potente actividad antagonista NMDA, se han usado en múltiples síndromes de dolor refractario. Describimos un caso de cefalea en racimos que no respondió al tratamiento estándar y se trató de forma efectiva con infusión intravenosa de magnesio y ketamina.


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Padilla del Rey M, Benítez Jiménez M, Canuel J, Díaz-Alejo Marchante C. NMDA antagonism in the treatment of cluster headache. Rev Soc Esp Dolor 2019; 26(4): 247-250 / DOI: 1020986/resed20193710/2018


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Publication history

Received: 30/09/2018

Accepted: 25/03/2019

Online First: 06/06/2019

Published: 31/07/2019

Article revision time: 173 days

Article Online First time: 249 days

Article editing time: 304 days


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