Watch for it – Ketamine for Migraine and More

Using ketamine for pain is not a new idea.  But I think we’re going to see it get an increasing amount of attention in the months ahead.

A few weeks ago, NPR featured a news story on the use of ketamine for depression.  Ketamine, originally developed as a human anaesthetic, has since been used for various applications in medicine.

Ketamine for depression, migraine, and more?

 It’s also used as an illegal drug, gaining fame as "K", "Vitamin K" or "Special K".

In recent years there has been sporadic interest in using ketamine for pain.  It’s a difficult drug to study, because it tends to be rather obvious that you’ve taken it.

But it has been suggested as a treatment for cluster headache, familial hemiplegic migraine, chronic daily headache, and migraine, as well as other types of pain.

Ketamine is a neurological drug, classed as a NMDA (N-methyl-D-aspartate) receptor antagonist.  It is believed to work in a number of different ways in the brain – relating to calcium channels, serotonin, and glutamate – terms that will be familiar with migraine researchers in particular.  In fact, ketamine has been especially useful in the treatment of headache or migraine that just won’t go away and isn’t responding to other kinds of treatment (refractory).  It’s given as an IV or intranasal treatment.  Of course, this means it’s way down on the list of treatments that will be given – it’s rare and even when it’s tried it’s often not successful.

However, with the growing interest in ketamine for depression, the game changes.  You can bet that there will be increased interest in ketamine for chronic pain conditions, which often come hand in hand with depression.

Although increased interest doesn’t mean this should be the drug of choice for most people, it does mean that more research will be done.  It may be a treatment that will help a few patients whose pain is seemingly unstoppable.

For more on the background of ketamine, read Ketamine and MDARs in the treatment of neuropathic pain from Dr. Jan M. Keppel Hesselink.  For a review of the studies on ketamine for other types of pain aside from headache, read Ketamine in Chronic Pain Management: An Evidence-Based Review

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4 comments… add one

  • Dr. Michael Zitney Apr 17, 2012

    Any help in treating these devastating conditions would be helpful, but I would be cautious about putting too much hope behind this. One of my patients with severe uncontrollable pain from bladder damage, got this from using ketamine recreationally. This is apparently a growing problem, which may be a matter of dosage.

  • Diana Lee Apr 25, 2012

    The doses one uses recreationally and that result in that kind of damage are much different than the doses uses in treatment.

    I used Ketamine for migraine for years. It works well for me by IV, but much less well in the ways that are easily usable at home by patients, including nasal spray and lollipop forms.

  • Elaine Jun 23, 2012

    I thought I had read recently that they’ve also come up with a transdermal treatment.

  • Rufus Dec 24, 2012

    Migraineurs should remain realistic. Ketamine works for some, but not others. I recently did a 5-day inpatient Ketamine treatment with a 24-hour a day drip, and only succeeded in throwing off what little equilibrium I had achieved in my Chronic Daily Migraine. It’s taken 2 months to get back to a “normal” level of daily pain. This was profoundly disappointing, as I’d spent 6 months fighting to have my insurance approve the treatment.

    Patients should also be truly prepared for the side effects. Many descriptions talk about possible hallucinations, but don’t really prepare you. If you’ve ever done LSD (I hadn’t for almost 25 years), you will have some idea. The psychotropic effects of ketamine in the hospital setting can be similar to LSD, but with less visuals. It can be extremely uncomfortable. My first night in the hospital, the doctors gave me too much too fast, and I literally had a bad, scary and nauseous trip that lasted for hours. They lowered the dose afterwards, but the feeling of a chemically altered state was quite uncomfortable, and the next few days on it did little for the migraine.

    This is not to try to scare everyone off of it, and perhaps I am supersensitive to the medication, but caution is warranted.

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