Migraines are among the most prevalent neurological conditions in the world, affecting about 40 million people in the United States and creating a substantial burden of disability. For many patients, acute and preventive treatments, including triptans, preventive medications, and lifestyle modifications, provide meaningful relief. But a subset of people with chronic migraine, medication-overuse headache, or refractory headache conditions find that standard therapies do not adequately control their symptoms (American Migraine Foundation, 2021).
At Initia Nova in Cherry Hill, we offer chronic headache and migraine treatment as a treatment option for patients with severe, treatment-resistant headache and migraine conditions. We use an individualized approach to determine whether ketamine may have a role within a broader headache management plan. For residents of South Jersey and beyond who have been managing debilitating headaches without adequate relief, understanding what ketamine-based migraine treatment involves, and what the evidence suggests, is an important starting point.
Understanding Migraine as a Neurological Condition
Beyond the “Headache” Label
The clinical reality of migraine extends well beyond what the word “headache” suggests. Migraine is a complex neurological disorder characterized by recurrent attacks that can include moderate to severe head pain, sensitivity to light or sound, nausea, and symptoms before or after an attack. The International Classification of Headache Disorders distinguishes multiple migraine subtypes, including migraine with aura, chronic migraine, and hemiplegic migraine. Chronic migraine generally involves headache on 15 or more days per month for more than three months, with migraine features on at least eight of those days (International Headache Society, 2018).
Chronic migraine can be profoundly disabling. Patients may find themselves unable to work, parent, or maintain social relationships during and after attacks. For people who have tried multiple preventive and acute therapies without adequate control, the search for effective treatment can become a defining feature of daily life.
The Neurobiology of Migraine: Central Sensitization
Contemporary migraine research recognizes central sensitization as an important concept in chronic migraine and other headache conditions. Central sensitization describes increased responsiveness in pain-processing pathways and may contribute to symptoms such as allodynia, or pain from normally non-painful stimuli, in some people with migraine (Suzuki et al., 2022).
The NMDA receptor system is one of several pathways involved in pain signaling and central sensitization. Because ketamine acts as an NMDA receptor antagonist, researchers have studied whether it may have a role in certain refractory headache presentations. That mechanism alone does not predict how any individual patient will respond.
How Ketamine May Help Treat Refractory Migraine and Headache
NMDA Receptor Antagonism and Pain Pathway Disruption
Ketamine has a long history of use in anesthesia and pain-management settings. Its role in migraine and refractory headache treatment is still being studied, particularly for patients whose symptoms have not responded adequately to established therapies (Cohen et al., 2018).
Research has included people with chronic migraine, new daily persistent headache, and other refractory intractable headache presentations. Retrospective studies have reported short-term reductions in pain for some patients, but those studies cannot establish which patients will experience durable benefit (Pomeroy et al., 2017; Schwenk et al., 2018).
Ketamine for Headache Is Not a First-Line Treatment
It is important to clarify that ketamine therapy for migraine and headache is not considered a first-line treatment. The evidence base remains limited, with a systematic review finding only five randomized trials and rating the overall evidence as very low certainty because of small samples, varied protocols, and differences in outcomes (Chah et al., 2021).
For this reason, we consider ketamine as one option within a comprehensive headache management plan, not as a replacement for neurological evaluation or established migraine therapies. Individual results vary, and ketamine is not appropriate for every headache presentation. You can learn more about the migraine treatment options we offer at Initia Nova.
What Patients With Migraine Can Expect at Initia Nova Cherry Hill
Evaluation and Candidacy
Our evaluation process begins with a thorough clinical assessment that includes headache history, prior acute and preventive treatment trials, current medication use, co-occurring conditions, and any previous neurological workup. We also consider whether additional evaluation or coordination with a neurologist or headache specialist may be appropriate before ketamine is considered.
Factors such as uncontrolled hypertension, certain cardiovascular conditions, psychosis-related concerns, substance use history, current medications, and other medical or psychiatric considerations may affect whether ketamine is appropriate. Careful screening and monitoring are central to responsible ketamine treatment (Cohen et al., 2018).
Patients considering treatment can review how to get ketamine treatment before scheduling an evaluation.
The Infusion Experience for Headache Treatment
Ketamine infusions for headache and migraine are administered intravenously in a supervised clinical setting. The treatment plan, dose, and scheduling are individualized based on the patient’s presentation, safety considerations, and response to care.
During an infusion, patients may experience dissociation, altered time perception, nausea, dizziness, or temporary changes in blood pressure. We monitor patients throughout treatment and prepare them for what they may experience before an infusion begins (Cohen et al., 2018).
Following an infusion, patients remain with us for monitoring before leaving. We provide individualized instructions about transportation and recovery, and patients should not drive on infusion days. Patients can also learn more about what to expect from ketamine infusion therapy and review our ketamine therapy FAQs.
Ketamine in the Context of a Comprehensive Headache Treatment Plan
Integration With Neurology and Other Headache Specialists
We do not view ketamine therapy as a replacement for neurological care or established migraine medicine. Patients may continue working with a neurologist or headache specialist while receiving care with us, and we support this collaborative approach.
Current migraine treatment may include acute medications, preventive medications, CGRP-targeting therapies, behavioral approaches, neuromodulation, and other interventions based on the patient’s diagnosis and history. For patients who have not yet explored established options, those treatments may warrant discussion as part of a broader headache-care plan (Ailani et al., 2021).
A Broader, Individualized Approach
For patients managing migraine alongside anxiety, depression, or other health concerns, we consider the full clinical picture when discussing options. Our goal is to provide thoughtful, individualized care while coordinating with appropriate specialists when needed.
At our Cherry Hill location, we approach headache treatment with the understanding that meaningful improvement may require time, careful monitoring, and more than one strategy. We believe patients deserve an honest conversation about the evidence, the uncertainties, and the options that may be appropriate for their individual situation. Read our Q&A with Dr. Patrick Sullivan on comprehensive treatment of migraine for additional clinical perspective.
Parting Thoughts
For South Jersey residents living with chronic migraine or refractory headache that has not responded adequately to standard treatments, ketamine therapy may be worth discussing as part of a comprehensive care plan. The current evidence is limited but evolving, and some studies suggest that ketamine may help a subset of carefully selected patients with refractory headache conditions (Chah et al., 2021; Pomeroy et al., 2017).
To explore whether ketamine for migraine or headache may be appropriate for your situation, contact our Cherry Hill office at (856) 543-6003. We are located at 1930 Marlton Pike E, Suite H-42, Cherry Hill, NJ 08003.
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy, TMS, SPRAVATO®, and other treatments described should only be pursued under the supervision of a licensed provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.
References
Ailani, J., Burch, R. C., Robbins, M. S., & Board of Directors of the American Headache Society. (2021). The American Headache Society consensus statement: Update on integrating new migraine treatments into clinical practice. Headache, 61(7), 1021-1039. DOI: 10.1111/head.14153. https://pubmed.ncbi.nlm.nih.gov/34160823/
American Migraine Foundation. (2021, January 21). What is migraine? https://americanmigrainefoundation.org/resource-library/what-is-migraine/
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. DOI: 10.17245/jdapm.2021.21.5.413. https://pubmed.ncbi.nlm.nih.gov/34703891/
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., Lubenow, T. R., & 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. DOI: 10.1097/AAP.0000000000000808. https://pubmed.ncbi.nlm.nih.gov/29870458/
Headache Classification Committee of the International Headache Society. (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1-211. DOI: 10.1177/0333102417738202. https://pubmed.ncbi.nlm.nih.gov/29368949/
Pomeroy, J. L., Marmura, M. J., Nahas, S. J., & Viscusi, E. R. (2017). Ketamine infusions for treatment refractory headache. Headache, 57(2), 276-282. DOI: 10.1111/head.13013. https://pubmed.ncbi.nlm.nih.gov/28025837/
Schwenk, E. S., Dayan, A. C., Rangavajjula, A., Torjman, M. C., & colleagues. (2018). Ketamine for refractory headache: A retrospective analysis. Regional Anesthesia and Pain Medicine, 43(8), 875-879. DOI: 10.1097/AAP.0000000000000827. https://pubmed.ncbi.nlm.nih.gov/29923953/
Suzuki, K., Suzuki, S., Shiina, T., Kobayashi, S., & Hirata, K. (2022). Central sensitization in migraine: A narrative review. Journal of Pain Research, 15, 2673-2682. DOI: 10.2147/JPR.S329280. https://pubmed.ncbi.nlm.nih.gov/36101891/