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Aura in some patients with familial hemiplegic migraine can be stopped by intranasal ketamine

From the Institute of Neurology (Dr. Kaube), The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; the Department of Neurology (Drs. Herzog and Dichgans), Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany; and the Department of Neurology (Drs. Kaube and Diener, and T. Käufer), University of Essen, Germany.

Address correspondence and reprint requests to Dr. Holger Kaube, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.

Migraine aura is probably caused by cortical-spreading depression. No treatment for acute and severe migraine aura has been described previously. The effect of ketamine (25 mg intranasally) was studied in 11 patients with severe, disabling auras resulting from familial hemiplegic migraine. In five patients ketamine reproducibly reduced the severity and duration of the neurologic deficits, whereas in the remaining six patients no beneficial effect was seen. Ketamine offers, for the first time, a possible treatment option for severe and prolonged aura.

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