Ketamine Therapy for Migraines

What the Evidence Says About Ketamine for Migraines

Ketamine for refractory migraine — migraine that hasn't responded to standard treatments — is an active research area, but a thin one. The 2018 ASRA/AAPM/ASA chronic-pain consensus guidelines took a cautious position across headache conditions, and their core finding applies: "evidence supports the use of ketamine for chronic pain, but the level of evidence varies by condition and dose range" — with migraine evidence resting on small studies rather than large randomized trials.

Patients exploring this option usually have chronic or refractory migraine and have exhausted preventives, triptans or gepants, and procedures like nerve blocks. Because relief in published reports is generally short-term, headache specialists treat ketamine as a bridge or last-resort option rather than a standing therapy — a framing worth expecting from any clinic offering it.

FDA status: No form of ketamine is FDA-approved for migraine. Generic (racemic) ketamine is FDA-approved as an anesthetic; its use for this condition is off-label, prescribed at a clinician's discretion.

Sources:

• Cohen et al., Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain (ASRA/AAPM/ASA, Reg Anesth Pain Med 2018)

Related Reading

• How Long Does Ketamine Last?
• Am I a Candidate for Ketamine Therapy?