Recent studies looked at the effectiveness of intranasal ketamine for treating persistent migraines that were unresponsive to other therapies. This article presents the research on intranasal ketamine's role in migraine management along with its abuse potential.

Intravenous ketamine for migraine

The Food and Drug Administration (FDA) first authorised the dissociative anaesthetic ketamine as a general anaesthetic in 1970. Since then, it has also been utilised for illnesses including depression and chronic pain.

According to research, treating refractory chronic migraine, also known as treatment-resistant migraine, may be helped by intravenous ketamine infusions. The medication has to be monitored by a pain expert, and therefore, up until now, the therapy has only been available in hospital settings. Researchers have begun to consider intranasal administration methods that individuals might utilise at home to boost the treatment's accessibility. While the FDA has approved an intranasal form of ketamine to treat depression, intranasal forms of ketamine have not been investigated for headaches or migraine.

The journal Regional Anesthesia and Pain Medicine published the research.

Study on intranasal ketamine spray

1. 242 patients with refractory chronic migraine were included in the trial. Nearly 80% of the participants were women, with an average age of 44. Daily headaches and anxiety or despair were common among the subjects.
2. Additionally, they had previously failed to take more than three preventative drugs. Each participant received a prescription for intranasal ketamine, which they were instructed to use up to 20 times per day and 40 times per week, once or twice in each nostril.
3. The subjects reported taking ketamine for 10 days each month, or around six sprays per day.
4. A few months after starting therapy, they were requested to participate in an interview.
5. Of the 169 research participants, 65% were still taking ketamine during the interview. In the end, 49% of individuals said ketamine was "very effective," and 36% said their quality of life had improved significantly.
6. Nearly 11% of individuals reported no improvement, 40% claimed ketamine was only somewhat helpful, and 2% indicated it worsened their migraines.
7. Although neck discomfort was the most frequent adverse effect, the researchers found that those who had depression, obstructive sleep apnea, or bipolar disorder were more likely to find intranasal ketamine therapy to be "very effective."
8. According to their analysis, 74% of individuals had at least one unfavourable side effect.
9. The most frequent adverse effects, in addition to neck discomfort, are weariness, double or blurred vision, disorientation or confusion, nausea, and dizziness.

Ketamine's migraine-relieving potential

Ketamine is a non-opioid analgesic and non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, which is believed to account for many of its effects on acute and chronic pain. Chronic migraine resistant to therapy may benefit from NMDA receptor inhibition, which stops the transmission of pain signals.

Some experts believe that the anti-inflammatory effects may be playing a role. Given that it is a dissociative anaesthetic that may make a person feel as if they are somehow apart from their suffering, ketamine can treat migraines. They could have a calmer, more detached sense of self, which might help lessen the effects of a migraine.

Ketamine abuse potential

The likelihood of abuse and dependence on ketamine nasal sprays is a major issue. The Drug Enforcement Administration has noted a danger of severe psychological dependency and low to moderate physical reliance. This is something to keep in mind while taking ketamine for medicinal reasons. It has to be adequately managed, monitored, and controlled.

Evaluating whether a particular patient might benefit from therapy is often wise. With the assistance of their doctor, the patient must make this choice after doing their research. Experts advise against using this approach as a first resort; instead, they recommend considering it for individuals who may be resistant to safer pain relief techniques or whose lives are significantly affected by migraine.

According to the experts, patients with a history of dependence shouldn't take this. Memory loss, drowsiness, and dissociation are potential side effects that might be more difficult for certain people than others. For example, those who have gone through trauma could find this distressing. It would be crucial to carefully monitor how each patient is affected in case therapy has to be changed or stopped.

Constraints of the study

The research's primary weaknesses are that it is a retrospective noncontrolled trial and that patients were permitted to use additional migraine preventive and abortive drugs during the study. This makes it very difficult to determine ketamine, another drug, a combination of drugs, or both cause an effect. This research was centred at a single medical centre with a majority of white women, including in the retrospective analysis, so it is difficult to generalise these findings. The investigators could not account for any extra drugs that patients could have been taking since this trial was open-label. Following therapy, follow-up pain ratings were gathered through phone calls many months later and may be biased by memory.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.