Ketamine is a medication that is sometimes used off-label for migraine treatment, and headache specialists on the cutting edge of migraine treatment sometimes prescribe it as a nasal spray or by in-patient infusion. Many patients aren’t aware that this is an option, and there is little known about what it is like to get an in-patient infusion, so I wanted to write a quick blog about my own experience at Jefferson Headache Center.
Ketamine is a drug that’s commonly used as an anesthetic due to its sedative effects on your central nervous system. It’s been used effectively outside of its traditional purpose to treat symptoms of depression, along with other chronic conditions such as migraine and other pain conditions.
To understand how ketamine works to reduce migraine pain, you first have to understand how the drug functions in your brain. Ketamine works by blocking neurotransmitters from reaching the N-methy-D-aspartate receptors (also known as NMDA receptors) and docking with them. These receptors are located throughout your brain and spinal cord and are very important in the development of pain. With ketamine treatment, because the transmitters can’t bind, the pain signal can’t be sent. As a result, the person feels a significant decrease in the severity of their pain.
Day 1
Day one is the longest day. Admission time is between 7-9am. You meet the doctors, residents, fellows, nurses, psychologist and nutritionist (last two might be required by your treatment plan).
You’ll meet the PICC team and they will place a PICC line typically in your right arm. A PICC line is a type of long catheter that is inserted through a peripheral vein into a larger vein in the body. After the PICC line is placed, you have to wait for the X-ray team to verify the placement of the PICC line. Once that is done, you can meet with the ketamine Team, althoughthis usually isn’t until 3pm. They will then verify your treatment plan, answer any questions you may have, and place the order for the ketamine. You typically start at 10 mg and the ketamine nurse will come by every four hours until 11pm to check on you and potentially increase your dose.
Note: No in-patient blog would be complete without talking about the food! At Jefferson, you have a great menu with many choices for breakfast, lunch, dinner and snack. You can order your meals whenever you’re hungry between 7am and 6pm.
Days 2-5
Days two, three, four and five are all about the same. You meet with the doctors, residents and fellows, as well as the psychologist and nutritionist if they are assigned to your treatment plan. Your ketamine infusion will continue to be increased based on how you are tolerating it; you may even go down on a dose before going up again if necessary due to side effects.
Everyone’s treatment plan is different. They are tailored to your individual needs. For example, one person might receive toradol, magnesium, zofran, B-12 and Ativan, while someone else might receive toradol, magnesium, xzanax and promethazine. You could even receive dexamethasone with magnesium. All the doctors, residents and fellows are very understanding and want you to be a part of your treatment plan. So if something isn’t agreeing with you, or you have a suggestion for something to try, it’s important to let them know!
Day 6—Discharge Day
On day six, which is discharge day, they wake you up at 5am to halve your ketamine dose. Then the ketamine nurse will come in at 9am and completely turn it off. You’re left on fluids for a little longer, you might get nerve blocks, and then discharge is usually around 12pm. At that point you may be sent home with a prescription for ketamine nasal spray, as well as potentially some new preventives and/or abortive medicines.
Follow-Up
It is very important to follow up with your headache specialist 2 weeks after your ketamine admission to discuss the treatment, how you are feeling, and how any new medicines you were prescribed are working for you.
Hi- thanks for sharing. Did it help? Was it scary? Hallucinations? Side effects?
Thanks!