Unlocking Relief: The Promise of Ketamine for Migraine Sufferers

Migraine headaches are pretty common, affecting 10% to as high as 20% of individuals in any population group. What is worrisome is that the cases of migraine headaches are rising. Yet, science is not fully sure of the cause of its rise. It means that a staggering number of people, that is, more than a billion individuals, are living with migraine headaches.

People have known about migraine headaches for centuries. In some individuals, these pains can be very severe and debilitating.

However, it is more important to realize that these are not just regular headaches. Migraine is a severe neurological disorder. This means that these headaches occur due to brain changes. Hence, painkillers may help, but they cannot cure the condition. That is why a better understanding of the disease mechanism is needed to find effective cures. Since ketamine increases neuroplasticity and promotes specific brain changes, its role in managing migraine headaches is beyond an analgesic.

Over the centuries, understanding of migraine headaches has improved. Till the mid of the 20^th century, people widely believed that it occurred due to some changes in blood vessels, due to throbbing or pulsating pain in many.

However, slowly, researchers noticed that there is more to the condition. It is not just about headaches but also about sensitivity to light and sounds, nausea, vomiting, and more. Moreover, many people also experience an aura, and they are able to predict when the migraine headaches will start, showing the complex nature of these headaches. Aura also points to the fact that the condition is neurological and causes specific brain changes.

Certain factors like sounds, food, alcohol, odors, stress, and anxiety, and more often trigger the condition.

In some, the pain is so severe that it causes significant disability. Moreover, the condition has other symptoms, like blurred vision, colored spots, seeing stars, tunnel vision, weakness, numbness, and more. Aura occurs in many, and it generally occurs 15 minutes to half an hour before severe headaches start.

Headaches in the condition may last for a couple of hours to a few days. In many cases, it is difficult to explain what causes these headaches, as they come abruptly and go abruptly. These aches are characterized by headache attacks and periods of relative calm.

Many people do have some symptoms, even during periods of relative calmness. They might feel fatigued, dull, depressed, and sleepy and may experience neck pain and other issues.

So, yes, migraine is a very complex neurological disorder that is not fully understood by science yet.

Any migraine treatment has two main objectives. The first is to abort migraine attacks or help reduce pain sensation. The second objective of any migraine treatment is to prevent future attacks.(1)

The reason why science is so interested in ketamine therapy is that it is an excellent painkiller or analgesic, and it can also alter the course of the disease. This means that ketamine is good for both phases. It is good for overcoming migraine headaches and preventing future attacks.

Causes of Migraine Headaches

Migraine is a multifaceted ailment. It means that it occurs for multiple reasons, which makes understanding the condition quite challenging. This means that every migraine patient is different and unique, and what works for one may not work for another. This poses specific challenges in managing the condition.

Researchers know many risk factors for the condition, including advancing age, genetics, hormonal imbalances, and more. It is also more likely to occur due to obesity, diabetes, hypertension, and metabolic disorders. Similarly, migraine risk is higher in those living with stress and anxiety. It is pretty likely that some autoimmune factors also play a role in the disease development. Irrespective of the causes, it would be right to say that it is a neurological disorder.(2)

When we say that it is a neurological disorder, it means that, ultimately, the cause of such frequent headaches is certain brain changes. Hence, when managing the condition, it is vital to consider drugs that may affect the working of the brain.

Doctors use a range of medications to manage the condition, like antiseizure drugs, neuromodulation devices, various painkillers, beta-blockers, and more. In recent years, researchers have also used calcitonin gene-related peptide (CGRP) to prevent migraine attacks. CGRP prevents vasodilation of certain brain blood vessels and thus prevents migraine attacks.(1)

Overall, there are many treatments and preventive measures, and none works for all. Hence, there is definitely a need to find novel treatments. This is the reason why doctors are now increasingly interested in exploring ketamine’s role in managing and preventing migraine headaches. Quite like other drugs, it may not work for all, but it may help in many instances. Moreover, ketamine is a potent pain killer and can modulate brain activity, making it a good choice for both preventing migraine headaches and managing acute migraine attacks.

Ketamine For Migraine Sufferers

There is a sound reason to consider ketamine for painful neurological conditions. This is because ketamine is not a regular painkiller. It is a potent painkiller with mind-altering properties. It is safe and has been used in medicine for over 50 years. It blocks the so-called NMDA receptors in the brain and many other receptors. What has further amazed doctors is that ketamine changes brain plasticity, which means that it continues to act for several days after the first dose. It continues to help even when there is no ketamine in the body. This happens because ketamine boosts certain brain chemicals and promotes brain rewiring.

There are many studies confirming that ketamine works, like one of the systemic reviews that looked at 20 clinical studies found that there is good evidence in favor of IV ketamine therapy for managing migraine.

Here, it is also vital to note that migraines are chronic neurological disorders. One of the issues with migraine is that many patients develop resistance to commonly used medications. This means that initially, they might benefit from the most commonly used painkillers. However, as the condition progresses, they stop responding to various drug therapies. This means that doctors need to keep changing treatments, opting for stronger medications like opioids, benzodiazepines, and other medications. Some of these medications are quite toxic. Even worse, many patients become resistant to some of the most potent painkillers like opioids and benzodiazepines.(3)

In recent years, researchers have been exploring ketamine IV therapy for resistant cases, that is, for patients who do not respond to other treatments. It is really encouraging to note that ketamine IV therapy may work when other medications fail.(3)

Yet, another use case scenario for IV ketamine therapy is severe migraine pain that NSAIDs, opioids, antihistamines, corticosteroids, and other drugs cannot sufficiently control. It appears that in some patients, migraine headaches are so severe that they need to visit the emergency department. However, the problem is that even doctors in the emergency department are not able to help such patients as they are resistant to so many painkillers. They simply do not know what to do in such cases. In recent years, researchers have been experimenting with ketamine (0.2–0.3 mg/kg intravenously), and it may work when other medications fail.(4)

Of course, ketamine is not the only anesthetic drug that doctors have been testing in migraine patients. There are many other medications, like lidocaine infusion. Lidocaine is also a potent anesthetic, though it works very differently from ketamine. Comparative studies show that ketamine IV infusion is quite comparable to lidocaine infusion in managing acute migraine headaches.(5)

Researchers have especially been motivated to use ketamine for refractory or resistant cases. In yet another clinical trial, they tested ketamine IV infusion for patients who were resistant to other treatments and were hospitalized for severe headaches. The study found that ketamine could help in such cases, and most patients reported benefits.(6)

However, ketamine is not just good for acute migraine. There is increasing evidence that it may be equally suitable for patients suffering from less severe chronic headaches. It is worth noticing that ketamine can alter brain function, and it may permanently change neuronal excitability. Hence, it may alter the course of the disease. Thus, it is also suitable for those living with chronic migraine. Researchers propose combining IV ketamine with other treatments like sub-cutaneous lidocaine to overcome chronic migraine.(7,8)

So, it means that different kinds of migraine patients might consider ketamine. It is quite good for managing acute and severe headaches. However, there is also a role for IV ketamine in managing chronic migraine. Repeated ketamine IV infusions may help prevent future migraine attacks.

How Does Ketamine Work in Migraine?

There is now much research ongoing to understand how ketamine works. Of course, a lot is known about ketamine, like it is an NMDA receptor antagonist. However, this mechanism is more likely to explain its anesthetic and analgesic properties. However, this effect does not explain a few things, such as how it could help with migraine headaches. Even more challenging to explain is how could possibly repeated IV ketamine infusions help prevent future migraine headaches. In fact, researchers have been struggling to explain how long-term ketamine effects occur, especially considering that after a single IV ketamine infusion, most of the ketamine has been removed from the body within 12 hours.

Nonetheless, in recent years, researchers have made some significant discoveries. One of the reasons why ketamine is so good for a broad number of conditions, from depression to migraine, is that it influences numerous pathways in the brain and not just NMDA receptors. It also influences serotoninergic and dopaminergic pathways and much more.

What is good about IV ketamine is that it also exerts neuroprotective action. Unlike other drugs, it does not harm neurons but rather promotes their recovery and regeneration. Hence, it can also promote brain rewiring, which may explain its long-term benefits.

New studies show ketamine does not increase intracranial pressure and improves blood flow to various brain areas. More importantly, it inhibits something called spreading depolarization (SD). SD is a phenomenon known to occur in damaged neurons, and it is harmful to brain cells and promotes brain inflammation. There is strong evidence from clinical studies that ketamine can prevent SD and thus lower brain swelling even after acute injury. This mechanism is likely to play an important role in reducing the severity of various neurological conditions. After all, neurodegeneration and inflammation are present in all neurological conditions.(9,10)

So, yes, ketamine is quite good for brain cells, and these findings are fascinating. There are very few anesthetics and analgesics known to possess such properties. It would be correct to say that ketamine works in many ways. It directly suppresses pain but also alters many brain pathways. More importantly, it may prevent brain damage and thus even promote regenerative processes.

How Safe is Ketamine for Migraine Management?

These concerns are valid, considering that ketamine is a controlled substance. Not only that, it is also a substance of abuse. The use of illicit ketamine is rising in some parts of the world. This is because, like most anesthetics, it does have mind-altering properties.

However, it is worth understanding that doctors use ketamine at lower dosages than anesthetic dosages when treating migraine headaches. At low doses and slow IV infusion, ketamine is much safer, and many of its side effects do not occur, or they are much milder. Of course, even at smaller dosages, it will still cause confusion and make thinking difficult. That is why one has to stay in the clinic for a few hours after the IV infusion.

There are a few other things that might occur with ketamine, like a small increase in blood pressure, nausea, vomiting, blurring of vision, and respiratory depression. Some individuals might be more sensitive to ketamine and may experience significant anxiety, disorientation, thoughts of fear, insomnia, flashbacks, and even hallucinations. However, these issues are generally short-lasting, especially when ketamine is used at lower dosages to manage migraine headaches.(11)

Of course, it is not a completely safe drug. That is why it is used strictly under doctors’ supervision. Its use in non-clinical conditions is prohibited.

Indeed, researchers are also experimenting with intranasal low-dose ketamine. However, it is not as good and effective as IV ketamine infusion given at a slow pace. Hence, doctors do not use ketamine in other ways.

The Bottom Line

Migraine is not just about headaches; it is a much more severe and complex neurological ailment. It also means aura, fear of light, inability to tolerate noises, irritability, fatigue, and many other issues. That is why regular painkillers have limited value in managing the condition. Even if regular painkillers work initially, most of those living with migraine would ultimately develop resistance to these drugs.

Another issue with migraine is that it is quite an unpredictable ailment. There are times when one may have frequent migraine attacks, and this may be followed by a period of relative calmness. For some, migraine attacks are pretty common. Similarly, pain intensity may also differ significantly among various patients.

As the condition is severe, debilitating, chronic, incurable, and might not respond to most commonly used painkillers, there is definitely a need for exploring ketamine’s role in managing the condition.

Of course, one of the ways in which ketamine may help is due to its analgesic properties. However, ketamine is more than an analgesic. It is known to alter brain function. Ketamine alters the excitability of neurons in various brain parts. Not only that, studies show that ketamine has some long-lasting effects on brain function.

This means that ketamine is a good choice for different scenarios. It is suitable for aborting migraine attacks. Moreover, studies show that IV ketamine infusion may even help abort migraine attacks when other medications fail. It is ideal for refractory migraine.

Further, ketamine is also suitable for chronic migraine. These are individuals who have frequent migraine attacks. Not only that, they also feel unwell during periods of remission. However, just a single ketamine IV infusion a week may provide much-needed relief to such individuals.

Although ketamine is not proven to cure the condition, but it may provide prolonged relief in many cases. Ketamine reduces brain inflammation, boosts blood flow to various parts, and promotes brain rewiring.

Another thing that one cannot neglect is that ketamine is also suitable for preventing migraine-related mental health issues. It is vital to understand that ketamine is not just headaches. Those with migraine may have many other problems like irritability, anxiety, higher risk of depression. Ketamine is known to stabilize mood and help.

To sum up, ketamine may not be a perfect migraine treatment; it might not work for all, but it is good for many migraine patients. What is good about it is that it may help in various scenarios. It is good for overcoming acute migraine headaches and preventing future migraine attacks. Repeated ketamine use may even alter the disease course.

References

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