Ketamine: A New Therapeutic Solution for Migraines
Debilitating head pain, sensitivity to light and sound, nausea—it sounds like you may have a migraine. Unfortunately, migraines are extremely prevalent, but, also unfortunately, this neurological condition is one that is known to be hard to treat.
While a number of pharmaceutical agents have been used to treat migraines, many of the traditional treatments come along with downfalls and unavoidable side effects. Ketamine, formerly used as an anesthetic, may offer new hope if you have migraines that have been especially hard to treat.
According to the Migraine Research Foundation, migraine is exceptionally prevalent. As many as 39 million people, including children, in just the United States are affected by migraines. Migraine is more common among women than men, and is most commonly an issue for people between the ages of 18 and 44, even though people of any age can suffer from these debilitating headaches.
The two primary types of migraine are a complicated migraine (with aura) and a common migraine (without aura). Aura describes a specific set of symptoms that point to neurological disturbances, such as bodily weakness and visual disturbances. However, migraine headaches can be classified further depending on symptoms. For example, an individual who has a migraine for at least 15 days in a single month could be diagnosed with chronic migraine.
Cluster headaches, which are not necessarily a type of migraine, can have similar symptoms. Cluster headaches usually don't last as long as a migraine, but the pain can be much more severe. These debilitating headaches can involve radiating, almost burning pain that makes your eyes swell and possibly even your nose to run. Cluster headaches are so severe that they have garnered the name "suicide headaches."
The primary characterizing symptom of a migraine is severe, throbbing head pain that may feel like a pulse on one side of the head. However, migraine may also be felt on both sides of the head as well. The pain can be so severe that someone with a migraine cannot function or continue with usual activities. Usually, migraines will be accompanied by other symptoms, depending on the stage of the migraine.
Migraines often progress through four distinct stages, but not for every individual. Here is a look at the different stages of a migraine and some of the symptoms that can come along with each stage.
Prodrome - 1-2 days before the migraine
Unusual food cravings
Stiffness of the neck
Aura - May occur immediately before a migraine or during a migraine
Weakness on one side of the face or body
Visual disturbances, such as light flashes or bright spots
Uncontrollable twitching or jerking
Feelings of "pins and needles" on arms or legs
Attack - Direct time of severe head pain
Pain on one or both sides of the head
Pulsing, throbbing headache
Heightened sensitivities to sound, light, or even touch or smell
Vomiting or nausea
Post-drome - After severe pain subsides
Fatigue or feeling drained
Short bursts of pain with head movement
Fatigue or feeling drained
How Migraine Differs from Ordinary Headaches
Migraine is actually considered to be a debilitating, disabling illness among those who suffer from the problem on a regular basis. Unlike a headache, migraine is usually labeled as a neurological disease because the pain is usually accompanied by so many other symptoms that can be all-out disabling. Unlike headaches, which often come about sporadically and don't involve accompanying symptoms, migraines sometimes follow a pattern or happen several times a month. Additionally, migraines can last up to 72 hours, while a typical headache will pass within a few hours or less.
Even though a great amount of research has gone into understanding migraines, a precise cause is not always known. Both genetics and other environmental factors are usually underlying factors. As far as genetics go, a child that has two migraine-suffering parents has a 75 percent chance of being a migraine sufferer as well. Other suspected causes that have been examined as of late include brain chemistry imbalances, such as serotonin imbalance, which actually regulates the nervous system and pain levels.
Most people who deal with migraines on a regular basis can point out certain triggers that seem to be related to their severe headaches. Some of the most common migraine triggers include:
Alcoholic or caffeinated drinks
Over-stimulation of the senses, such as bright lights, loud noises, or strong smells
Changes in the weather
Changes in sleep patterns or schedules
Certain foods of food additives
Medications, such as vasodilators or birth control
Migraine treatment can be complicated because the underlying cause is not always known. Many sufferers will try a multifaceted approach to dealing with frequent migraines.
Many individuals work to make lifestyle changes to avoid their known migraine triggers. For example, if an individual recognizes over stimulation of their senses as a migraine trigger, they may work to avoid excessive exposure. Likewise, if a female is dealing with migraines monthly associated with hormonal fluctuations during her menstrual cycle, she may work with a doctor to find a way to stabilize her hormone levels.
Over-the-Counter Pain Relievers
Over-the-counter migraine treatment tends to be haphazard at best. Typical headache medications don't always help for migraines, or at least not with the host of symptoms that can come along with the headache. Taking certain over-the-counter medications like ibuprofen or even aspirin for more than 10 days a month to help with migraine pain can sometimes actually trigger more headaches.
Prescription Migraine Medications
Prescription medications for migraine tend to fall into one of two types: medicine to relieve the pain or symptoms during an attack or medicine to prevent migraines. Those often prescribed to thwart the risks of having a migraine or to lessen the severity tend to be medications primarily designed for other issues. For example, some doctors will prescribe beta blockers normally prescribed for high blood pressure or antidepressants normally given for depression. While some of these medications show some efficacy for some people, most come along with highly concerning side effects.
Several medications may be prescribed for people to use during a migraine attack, such as opioid pain medications, triptans that are designed to block neural pain paths to the brain, and even anti-nausea drugs. Many of these drugs can have some level of effectiveness, but all of them can come with undesirable side effects. For example, lasmiditan has a tendency to act as a sedative and opioid pain medications are extremely addictive and not ideal for long-term treatment.
Onabotulinumtoxin A, otherwise referred to as Botox-A, is another prescription option for some types of migraines. Botox must be injected in targeted points in the neck and head, and the effects can last for about three months. Unfortunately, even Botox can come along with undesirable side effects, such as blurry vision or eyebrow drooping.
Ketamine has been in use for decades as an anesthesia medication. The anesthetic is classified as a "dissociative anesthetic" because it induces sedation uniquely compared to other medications of the same class. While ketamine at high doses can induce a trance-like state or sedation, lower doses can be exceptionally effective for relieving severe pain.
Ketamine has an analgesic effect that occurs without interfering with opiate receptors in the brain like opioid pain medications. In fact, the medication has been used to help deter pain for people coming out of especially painful surgical procedures instead of opioids. Instead of acting on opioid receptors, ketamine affects the N-Methyl-D-aspartic acid (NMDA) receptors in the brain, so it sort-of acts a signaling molecule via this receptor to deter pain. The drug has naturally gained attention for certain hard-to-treat types of pain, such as migraine.
Research Behind Ketamine Nasal Spray for Migraine
Several studies have examined ketamine for its efficacy against specific types of chronic pain, including refractory headaches, a debilitating type of migraine. In 2012, researchers found that 49 patients who took part in the study and received ketamine infusions intravenously experienced significant pain reduction. Another study in 2013 found that intranasal ketamine helped migraine sufferers who were dealing with prolonged aura.
In 2017, a study involving 61 migraine sufferers showed that 75 percent experienced improvements with their migraine severity in just a three to seven-day course of ketamine infusion therapy. Even more noteworthy, pain ratings on a scale of 1 to 10 fell from 7.5 at admission to 3.4 on discharge. All of these patients were experiencing migraines that did not improve with other treatment.
In 2019, researchers examined the effectiveness of intranasal ketamine for pediatric migraine sufferers. Each of the patients were given intranasal ketamine doses during the study, the entire group had a collective 66 percent reduction in migraine pain, and the side effects were generally mild and passed quickly.
Work with a Compounding Pharmacy to Obtain Ketamine Nasal Spray
With ketamine offering so much promise as a potential agent to help migraine sufferers, more patients who deal with these debilitating headaches on a regular basis are taking note. If you are one of those people who are ready to find a migraine treatment that may offer relief, please reach out to us at Harbor Compounding Pharmacy. Our pharmacists can work with you and your doctor to determine if intranasal ketamine could be right for you.