When Chronic Migraine Becomes Difficult to Manage
Chronic migraine involves headache on 15 or more days per month and can be profoundly disruptive to work, relationships, and daily life. For patients who have not found enough relief with preventive medications, CGRP-targeting treatments, Botox injections, or acute therapies, the search for another option can feel like a closed loop.
At Albany Ketamine Infusions, we may consider IV ketamine as an off-label option for carefully selected patients with treatment-refractory migraine and chronic headache syndromes.
Understanding Migraine and Chronic Pain Processing
The relationship between pain and the brain is more complex than most people realize, and nowhere is that complexity more apparent than in migraine. Migraine is not simply a bad headache. It is a neurological condition involving processes such as cortical spreading depression, trigeminovascular activation, and central sensitization.
Central sensitization can contribute to heightened pain sensitivity over time. This may help explain why standard treatments do not provide enough relief for every patient, particularly when symptoms have become chronic or difficult to manage. Understanding what neuropathic pain is and how it relates to sensitization can help patients better grasp why some headache disorders become so persistent.
Why Ketamine Is Being Studied for Migraine
Ketamine’s relevance to migraine lies primarily in its action on NMDA receptors. Researchers have explored NMDA receptor antagonism as one potential way to influence pain processing and central sensitization. The precise role of ketamine in migraine care remains under study, and available research is still limited.
Several academic headache and pain programs have used IV ketamine in closely monitored settings for patients with refractory headache disorders. Studies have reported short-term improvements for some patients, but larger controlled trials are still needed to clarify who is most likely to benefit and how long improvement may last.
Our approach is individualized. We consider the severity and history of the headache disorder, prior treatments, medication use, relevant coexisting conditions, and whether ketamine may be an appropriate addition to the patient’s existing care plan.
How We Evaluate Headache Patients
At Albany Ketamine Infusions, our evaluation for headache patients is thorough. We consider the type of headache disorder, its history, prior treatment experience, and factors such as medication-overuse headache, sometimes called rebound headache.
We also take the whole person into account. Chronic migraine can affect mood, sleep, daily functioning, and quality of life. Our goal is to understand the patient’s complete clinical picture rather than focus only on headache frequency.
Patients can learn more about our treatment planning process at a ketamine clinic before deciding whether to schedule a consultation.
What IV Ketamine Treatment Involves
Our IV ketamine infusions are administered under the direct supervision of Dr. Philip Hansen, a board-certified anesthesiologist. Dosing, treatment frequency, and monitoring are individualized based on the patient’s presenting condition, medical history, prior medications, and response to care.
Sessions take place in private treatment rooms, with vital signs monitored throughout the infusion. We discuss preparation, transportation, possible side effects, and follow-up before treatment begins.
Ketamine is not a permanent cure for migraine. Some patients may experience meaningful improvement in headache frequency or severity after treatment, while others may not respond or may need a different care plan. Duration of benefit varies substantially by individual. For a deeper look at what to know about ketamine therapy for pain management, our dedicated resource covers key considerations for prospective patients.
Ketamine as Part of Coordinated Care
Ketamine should be considered as part of a coordinated headache-management plan, not as a replacement for established neurological care. Medication use can affect both treatment planning and expected response, so we review all current medications carefully during intake.
When appropriate, patients should continue working with their neurologist, headache specialist, primary care clinician, or pain-management team. This is especially important for people managing complex migraine histories or other chronic pain conditions. Our post on supporting a loved one with chronic migraines offers additional perspective on how migraine affects families and caregivers navigating these challenges together.
Cost and Practical Considerations
IV ketamine for migraine and chronic headache is off-label, and insurance coverage may vary. We discuss cost and practical considerations openly from the beginning so patients can make informed decisions about treatment.
Financial concerns are real for people living with disabling headache disorders. We believe patients deserve clear information about their options, expectations, and the role ketamine may or may not play in their care.
When Migraine Requires Urgent Evaluation
Status migrainosus, generally defined as a migraine attack lasting longer than 72 hours, can be especially debilitating. An outpatient ketamine clinic is not a substitute for emergency care.
Patients should seek urgent medical evaluation for severe, sudden, changing, or otherwise concerning headache symptoms. Our role is to help patients understand whether outpatient ketamine treatment may be appropriate within the scope of their broader care plan.
Frequently Asked Questions
For additional practical information, visit our Frequently Asked Questions page.
Is ketamine FDA-approved for migraine or chronic headache?
No. IV ketamine for migraine and chronic headache is off-label. Off-label prescribing is an established medical practice, but it should involve a careful discussion of the evidence, potential risks, alternatives, and individual circumstances.
How is ketamine different from triptans or CGRP medications for migraine?
Triptans, CGRP-targeting medications, and ketamine act through different mechanisms. Ketamine is being studied for its effect on NMDA receptors and pain processing, while standard migraine treatments may target other pathways involved in migraine attacks. Ketamine is not a replacement for standard migraine care. We consider whether it may be an appropriate addition for patients whose symptoms have remained difficult to manage.
How many infusions are typically needed for chronic migraine relief?
Treatment plans vary. The number and timing of infusions depend on the patient’s headache history, prior treatment response, health considerations, and goals of care. We track headache frequency, severity, and overall response throughout treatment.
Can ketamine help with depression that often accompanies chronic migraine?
Depression and anxiety can occur alongside chronic migraine, and we consider mood symptoms as part of the full evaluation. However, each condition should be assessed individually, and treatment planning should account for the patient’s complete clinical picture.
What should I do to prepare for a ketamine infusion if I have a headache condition?
We provide specific pre-infusion instructions during intake. Preparation includes reviewing current medications, following clinic guidance about food and fluids, arranging transportation, and discussing any symptoms such as light or sound sensitivity that may affect the treatment environment.
Key Takeaways
- Chronic migraine involves complex neurological and pain-processing mechanisms that may not respond fully to standard treatments.
- IV ketamine is an off-label option that may be considered for selected patients with treatment-refractory migraine or chronic headache symptoms.
- Research suggests ketamine may provide short-term benefit for some refractory headache patients, but larger controlled studies are still needed.
- Treatment plans are individualized based on headache history, prior therapies, medication use, medical considerations, and response to care.
- Results vary by individual. Discuss with your neurologist, headache specialist, and our team whether IV ketamine may be an appropriate addition to your care plan.
Conclusion
Chronic migraine can take time, productivity, relationships, and quality of life from the people living with it. Patients who have not found enough relief with conventional options deserve a thoughtful, individualized conversation about what may come next.
At Albany Ketamine Infusions, we bring the clinical oversight of a board-certified anesthesiologist to the management of complex pain conditions, with a commitment to honest, coordinated care. If you are living with chronic migraine in the Albany area and want to discuss whether IV ketamine may fit into your treatment plan, we invite you to schedule a consultation with our team today.
About Dr. Philip Hansen
Dr. Philip Hansen is a board-certified anesthesiologist who trained at Albany Medical Center. He established Albany Ketamine Infusions in partnership with Dr. Brooks, building on his training at NY Ketamine Infusions. Dr. Hansen graduated from the University of Kansas School of Medicine and holds membership in the American Society of Anesthesiologists, the American Medical Association, and the New York State Society of Anesthesiologists. He provides medical oversight for in-office IV ketamine infusions.
Works Cited
Chah, N., Jones, M., Milord, S., Al-Eryani, K., & Enciso, R. (2021). Efficacy of ketamine in the treatment of migraines and other unspecified primary headache disorders compared to placebo and other interventions: A systematic review. Journal of Dental Anesthesia and Pain Medicine, 21(5), 413–429. https://doi.org/10.17245/jdapm.2021.21.5.413
Cohen, S. P., Bhatia, A., Buvanendran, A., Schwenk, E. S., Wasan, A. D., Hurley, R. W., Viscusi, E. R., Narouze, S., Davis, F. N., Ritchie, E. C., & Hooten, W. M. (2018). 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. Regional Anesthesia and Pain Medicine, 43(5), 521–546. https://doi.org/10.1097/AAP.0000000000000808
International Headache Society. (n.d.). 1.3 Chronic migraine. The International Classification of Headache Disorders, 3rd edition.
Lauritsen, C., Mazuera, S., Lipton, R. B., & Ashina, S. (2016). Intravenous ketamine for subacute treatment of refractory chronic migraine: A case series. The Journal of Headache and Pain, 17, 106. https://doi.org/10.1186/s10194-016-0700-3
Ramadan, N. M. (2003). The link between glutamate and migraine. CNS Spectrums, 8(6), 446–449. https://doi.org/10.1017/S1092852900018727
Medical Disclaimer
The information provided in this blog is for educational purposes only and does not constitute medical advice. Treatment outcomes vary by individual. Results may vary. Please consult with a qualified healthcare provider before beginning any new treatment. Discuss with your provider whether this treatment is appropriate for you.