Ketamine May Relieve Migraines
Each year, American workers miss over 113 million workdays due to migraines, making the chronic illness the sixth most debilitating in the world. More than mere headaches, migraines often cause intense pain, hypersensitivity, and nausea, among other symptoms. These impacts make it impossible for 90% of sufferers to function normally in the midst of an attack.
But despite these staggering statistics, migraines are notoriously difficult to treat. There is no known cure, and management can involve testing a slew of medications and lifestyle changes. However, recent research suggests that relief may come from an unexpected source: a medication called ketamine. Although this substance has gained notoriety as a recreational drug, studies are indicating that it may effectively relieve the pain and other symptoms associated with different types of migraines.
What Is Ketamine?
Ketamine is a Schedule III drug that is most often used in a hospital setting. It was first discovered in 1962 and was first tested for use in humans two years later. In most cases, this medication is used for anesthetic purposes, specifically to begin and maintain anesthesia during surgery. The drug relieves pain, it produces feelings of relaxation, and it induces memory loss. It also causes loss of consciousness in higher doses, thus making it useful for surgical procedures. In fact, it was originally approved for this purpose by the FDA in the 1970s.
When someone is under the influence of ketamine, airway reflexes, breathing and heart function typically remain intact. This makes it one of the safer choices available for anesthetic purposes. Unfortunately, ketamine is still a powerful drug and may cause complications when abused. In addition, ketamine can produce dissociative effects and hallucinations. As a result, it is sometimes used for recreational purposes.
Ketamine is available in the form of an intramuscular injection, an IV infusion, pills and a nasal spray. When ketamine is used to treat chronic pain, migraines and other issues, it is usually administered as an infusion given through an IV. Ketamine infusions are generally considered to be safe. However, like all medications, ketamine does have the potential to cause side effects. Patients should be mindful of side effects and report any issues to their doctor. During a ketamine infusion, medical professionals will typically be present to monitor the patient for any complications.
In some research studies examining the effects of ketamine on migraine pain, the drug was administered as a nasal spray.
Ketamine as a Treatment for Pain
The FDA has approved ketamine for use as an anesthetic, as well as for pain control. However, since its discovery, studies and anecdotal reports have shown that ketamine may also be useful for other purposes in lower doses. Some of the other conditions ketamine may be able to treat effectively include anxiety, obsessive-compulsive disorder, post-traumatic stress disorder and depression, as well as chronic pain syndromes including reflex simplex dystrophy, fibromyalgia and central sensitization syndrome. In addition, ketamine may be able to reduce the pain associated with migraine headaches.
At this time, the FDA has not approved ketamine for the treatment of any of these conditions. Thus, using ketamine to treat these issues is considered an “off-label” use of the drug. As a result, most health insurance companies will refuse to pay for ketamine infusions when they are being used to treat migraines.
Ketamine and Migraines
Used medically as an anesthetic and pain medication as an alternative to narcotics, ketamine may soon be used to treat migraine sufferers. A recent study showed that 75% of patients tested experienced significant pain relief from between three and seven days of ketamine treatment. Another research group found that treatment with a ketamine nasal spray reduced the severity of aura (sensory disturbances that often precede or accompany migraines). >A third showed that outpatient ketamine treatment cut pain levels in half across five groups of migraine sufferers. While these studies have limitations, they suggest a promising avenue of research for migraine relief.
How Does it Work?
Given these results, it’s worth asking why ketamine has been successful in treating some migraine pain. Unfortunately, we don’t know. We do know that ketamine acts on a certain type of receptor in the brain called the NMDA receptor, and that blocking this structure changes the way the brain forms connections. The link between this biological mechanism and the observed pain relief, though, is less clear. Research is ongoing, as the answer may lead to insights into medical conditions ranging from depression and OCD to chronic pain.
Where Do We Go From Here?
While some headache specialists use ketamine off-label for their migraine patients, researchers caution that ketamine is not ready to be used extensively yet. It also had not yet been approved by the FDA, although that mainly implies a need for further testing. Concerns include the potential for side effects, including psychoactive effects such as an “out of body experience”, along with questions about how long the treatment lasts.
Still, the preliminary data shows that migraine patients have good reason to be hopeful. Ketamine appears to treat symptoms and has other benefits, such as lacking the same addictive qualities as opiate alternatives. With more rigorous testing, ketamine may well become a valuable tool in the fight against intractable migraines.
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