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Researchers say a nasal spray may be an efficient way to administer ketamine. ProfessionalStudioImages/Getty Images
  • Researchers investigated intranasal ketamine for treatment-resistant chronic migraine.
  • Around half of participants in a study reported the treatment was “very effective.”
  • Further studies are needed to investigate which people are best suited for the treatment.

Ketamine is a dissociative anesthetic that was initially approved by the Food and Drug Administration (FDA) in 1970 as a general anesthetic.

It has since been used for depression and pain conditions as well.

Among pain conditions, studies indicate that intravenous ketamine infusions may be useful for managing treatment-resistant migraine headaches, also known as refractory chronic migraine.

Until now, however, the treatment has been limited to hospital settings as it requires a pain specialist to monitor dosage. To increase the treatment’s accessibility, researchers have started to consider intranasal delivery options that people can use at home.

While an intranasal version of ketamine, known as Spravato, has been approved by the FDA to treat depression, intranasal versions of ketamine have not been studied for headaches or migraine.

Recently, researchers examined the effects of intranasal ketamine for treating refractory chronic migraine among people who did not respond well to existing treatments, including ketamine infusion.

They reported that intranasal ketamine reduced headache intensity by a small or large degree in 89% of patients as well as improving the quality of life for around a third of study participants.

The researchers cautioned, however, that due to the drug’s potential for overuse, it should be reserved for people as a “rescue treatment” alongside appropriate safety precautions.

Their study was published in the journal Regional Anesthesia and Pain Medicine.

For the study, the researchers recruited 242 people with refractory chronic migraine.

The participants were an average age of 44 years old and nearly 80% were women.

Most participants had daily headaches and anxiety or depression. They had also tried more than three preventive medications beforehand without success.

All of the participants were prescribed intranasal ketamine and told to spray once or twice in each nostril, up to 20 sprays per day and 40 sprays per week.

The participants reported using an average of around six sprays of ketamine per day for an average of 10 days per month. They were asked for an interview several months after commencing treatment. At the time of the interview, of the 169 participants in the study, 65% were still using ketamine.

Ultimately, 49% of participants reported that ketamine was “very effective” and 36% reported that their quality of life was “much better.”

Meanwhile, about 40% reported that ketamine was somewhat effective, nearly 11% reported no change, and 2% of participants said that ketamine worsened their migraines.

The researchers noted that while neck pain was the most common side effect, the participants with depression, obstructive sleep apnea, and bipolar disorder were more likely to find intranasal ketamine treatment “very effective.”

They wrote that 74% of patients reported at least one negative side effect. Besides neck pain, the most common side effects were fatigue and double or blurred vision, confusion or disassociation, nausea and dizziness.

Medical News Today asked Dr. Vanessa Cooper, an assistant professor at Yale School of Medicine in Connecticut who was not involved in the study, how ketamine may help relieve migraine.

“Ketamine is a non-opioid analgesic and non-competitive- N-methyl-D-aspartate (NMDA) receptor antagonist, which is thought to be responsible for many of its effects in acute and chronic pain,” she explained. “Inhibition of NMDA receptors results in termination of pain transmission may be beneficial in the treatment of refractory chronic migraine.”

Dr. Tyler Kjorvestad, a clinical assistant professor of psychiatry and behavioral sciences at The University of Kansas Medical Center who also was not involved in the study, told Medical News Today that there are several ways ketamine may help with headaches.

“Additionally, it may have anti-inflammatory effects that are similar to over-the-counter medications such as Tylenol and ibuprofen that could be playing a role as well,” he said.

Medical News Today also spoke with Lea McMahon, LPC, EdD, the chief clinical officer at Symetria Recovery who was not involved in the study, about how ketamine may feel for a person experiencing pain relief.

“Ketamine has the potential to relieve migraine as it is a dissociative anesthetic, which can cause a person to feel a sort of separation between themselves and their pain. They may feel calmer and more detached from their surroundings, which could also reduce the impact of a migraine,” she said.

“My major concern about ketamine nasal sprays is the potential for misuse and dependency,” said McMahon.

“The [Drug Enforcement Administration] has identified a risk of low to moderate physical dependence, and high psychological dependance. It’s important to be mindful of this when using ketamine for medical purposes. It must be properly controlled, regulated, and administered,” she added.

McMahon noted that most people continued to use the spray despite experiencing unpleasant side effects. While she acknowledged this may have been due to migraine symptom relief, she cautioned that it may also indicate dependency in some cases, especially as many patients reported daily usage.

“It’s often advisable to assess whether treatment is appropriate on an individual level. This needs to be an informed decision made by the patient, with the support of their physician,” McMahon said. “This option should not be the first port of call, rather, it should be considered for patients who may be treatment resistant to safer pain management methods, or whose lives are being severely impacted by migraine.”

“I would not recommend this option for patients with a history of dependency,” she added. “There is a risk of side effects including memory loss, sedation, and dissociation, which could be more challenging for some individuals than others. Those who have experienced trauma, for instance, may find this triggering. It would be essential to properly monitor the effect it has on each patient in case treatment needs to be adjusted or discontinued.”

“The major limitations of the study are that it is a retrospective noncontrolled trial and that patients were allowed to take other preventative and abortive medications for migraines during the process,” Kjorvestsad noted. “It makes it very challenging then to isolate if this effect is from ketamine or from the other medications or combination of both ketamine and these medications.”

“It’s difficult to generalize these results as this study was based at a single hospital center with predominantly white women, including in the retrospective analysis,” Cooper added. “This study was open label; therefore, the authors were unable to control for additional medications that patients may have been also taking. Follow-up pain ratings were obtained via telephone call several months after treatment and could be subject to recall bias.”

“Future double-blind placebo-controlled clinical trials will be required to confirm these findings in patients with chronic refractory migraine,” she concluded.