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Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43:521–46.
N-methyl-D-aspartate receptor open-channel blockers memantine and magnesium modulate nociceptive trigeminovascular neurotransmission in rats. Eur J Neurosci. 2019;50:2847–59.
Ketamine infusions for chronic pain: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg. 2019;129:241–54.
It can be hard to imagine a headache that lasts for days and entirely disrupts your daily life. According to the Migraine Research Foundation, around one in four U.S. households has a member suffering from debilitating headaches.
Libertas Mind offers specialized outpatient infusions to treat pain including migraines. Ketamine, an off-label treatment for depression, is emerging as an important medication in this regard because of its NMDA receptor antagonism.
Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43:521–46.
N-methyl-D-aspartate receptor open-channel blockers memantine and magnesium modulate nociceptive trigeminovascular neurotransmission in rats. Eur J Neurosci. 2019;50:2847–59.
Ketamine infusions for chronic pain: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg. 2019;129:241–54.
Individuals susceptible to migraine have differences in how dopamine is sensed in the body. Some with headaches have an increased responsiveness to dopamine. The advantage of these medications is they’re effective and can be used in pregnancy. The disadvantage: extrapyramidal side effects
The data here is quite clear. Dopamine agonists were more powerful and effective than hydromorphone- a very strong pain medication.
EJNEUROLOGY. 2017;89(20):2075. EPUB 2017 OCT 18.
J EMERG MED. 2002;23(2):141.
NEUROLOGY. 2003 JAN;60(2):315-21.
EJNEUROLOGY. 2017;89(20):2075. EPUB 2017 OCT 18.
J EMERG MED. 2002;23(2):141.
NEUROLOGY. 2003 JAN;60(2):315-21.
Magnesium like ketamine binds to NMDA receptor and maintains calcium homeostasis. It also modulates release of Substance P & production of nitric oxide (process involved in migraines). Given alone it can be a potent vasodilator. Magnesium seems to prevent cortical spreading depression, a type of brainwave signal seen in migraines.Fortunately it is well tolerated with occasional side effects of diarrhea, flushing, and temporary weakness.
An important recent study of 234 migraine patients treated with IV 2 grams magnesium decreased pain from 5.5 to 3.5 after magnesium infusion. Of the 104 patients (44%) who received IV magnesium they did not require additional intramuscular (IM) medications for pain.
CLINICAL NEUROLOGY AND NEUROSURGERY 178 (2019): 31-35.
CLINICAL NEUROLOGY AND NEUROSURGERY 178 (2019): 31-35.
Ketamine has made a number of headlines recently in regards to migraines.
The Ket Head trial – a multicenter, placebo-controlled, randomized controlled trial – was launched to evaluate the effect of high-dose IV ketamine infusions (compared to placebo) on the number of headache days at 28 days post-infusion. Participants will be randomized to either ketamine (1 mg. kg−1 bolus followed by infusion of 1 mg. kg−1. h−1 for 6 h) or placebo (0.9% saline in the same volume and infusion rate as the trial medication) bolus and infusion for 6 h.
Intranasal (IN) ketamine recently demonstrated strong results in treatment refractory migraine patients who already tried 4 or more medications in multiple classes. Published in Regional Anesthesia & Pain Medicine May of 2023, of the 169 patients followed in their retrospective review, half of the participants found IN ketamine “very effective,” and 40% found it “somewhat effective.” Up to 80% of participants co.ntinue to use IN Ketamine.
Thomas Jefferson University, perhaps an institution with the most experience treating migraines with ketamine published a retrospective study of sixty-one patients who underwent five-day intravenous ketamine therapy sessions in Regional Anesthesia & Pain Medicine 2018. They found 77% success rate, with 40% experiencing sustained relief.
Ketamine’s efficacy for migraines may lay in it’s unique ability to reverse central sensitization. This neurological phenomenon, where repetitive stimulation of a nerve leads to increased excitability , is common in headache disorders.
As more data is reviewed, it seems safe to conclude there is a role for Ketamine in the treatment of intractable migraines. Libertas mind also offer specialized nerve injections – different than Botox- called Sphenopalatine ganglion and Stellate ganglion nerve blocks for migraine relief. Contact Libertas Mind for more information.
Learn more about the different treatment options available.
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