How Do IV Ketamine Infusions Treat Migraine?

Many of the medications used to treat migraine disorder are repurposed or “off-label” antidepressants, antipsychotics, or anti-epileptics. It hasn’t been until recently that a whole new class of drugs, called CGRP monoclonal antibodies, were developed expressly for this condition.

Unfortunately, not everyone is a good candidate for the new drugs, leaving people wondering how they can beat the disease.

At the office of Dr. Michael Kullman, we treat all types of headache disorders, including migraine. As many patients are treatment-resistant to antidepressants and CGRP antibodies, and as most of the off-label drugs only treat part of the problem, we offer IV ketamine therapy to our migraine patients with great success. Here’s how it works.

Migraine 101

According to the Migraine Foundation, migraine is the third most prevalent and sixth most disabling disease in the world. Not just a headache, it’s an extremely incapacitating collection of neurological symptoms.

Migraine is considered episodic if you have 14 or fewer headache days a month and is considered chronic if you have 15 or more headache days a month, with at least eight of those presenting with migraine symptoms.

Migraine usually goes through four discrete phases, though not everyone gets all four, and some get only one.

1. Prodrome

This phase can start the day before an attack hits, or even several days in advance. Everyone has a different experience, but common symptoms of this phase are excessive yawning, moodiness, brain fog, an unsettled feeling, and unspecified pain coming up the back of your neck.

2. Aura

Generally, you either get aura or you don’t get it; there’s no mixing of the two types. If you have aura, the most common symptoms are seeing flashing lights, lightning bolts across your vision, or twinkling stars. You may also experience a sense of “unreality” or have a version of aphasia, where you garble your speech. This phase generally lasts up to 20 minutes.

3. Pain

This is the phase people think about when they hear “migraine.” The pain usually comes on sharply, throbbing behind the eye on one side of the head, and movement of any kind makes it worse. You may also have accompanying nausea and vomiting; sensitivity to sound, smell, or touch; and an inability to focus on anything other than the pain.

The pain may last as short as four hours and as long as 72 hours before you get any relief.

4. Postdrome

No, it isn’t over yet. The pain may have ebbed, but the orbits around your eyes probably still hurt, and you experience something like a post-adrenaline crash. You’re too tired and weak to do anything, and you’re still mentally foggy. This phase can last up to two days.

Ketamine infusions

Ketamine was first used in Belgium in the 1960s as a veterinary anesthetic. In 1970, the FDA approved its use as an anesthetic for people, and it made its way onto battlefields and into ORs. 

Emergency responders discovered that, if they gave it to an agitated person, the person became calm and less depressed. That’s when doctors realized its powerful use for treatment-resistant depression.

As a dissociative anesthetic, ketamine also addresses pain. Instead of working with the ubiquitous neurotransmitter serotonin, which is targeted by many antidepressants, it, instead, regulates the levels of glutamate, a neurotransmitter known for its effects on mood and pleasure.

Given at the onset of a migraine attack, the ketamine adjusts glutamate levels before the pain phase hits, effectively preventing it. And if you’re in the middle of the pain phase, it regulates transmitter levels to diminish the painful sensation.

If you’ve tried pain treatment after pain treatment and still endure migraine attacks, ketamine therapy may be a solution for you. To learn more or to schedule an evaluation, call our office at 914-465-2882, or visit our website for more options.