Ketamine Applications for Migraines: A Scoping Narrative Review

In the United States alone, nearly 40 million children and adults suffer from migraines, which are the primary cause of morbidity, quality of life reduction, and loss of productivity for persons aged 15-49. Despite their global prevalence and various available treatment options, these disabilities are often still under-treated due to the individuality of treatment regimens and effect profiles. Compelling arguments have been made for ketamine use in opioid-sparing pain management. An increase in opioid stewardship, especially during the outbreak of the novel COVID-19, has only accentuated arguments for ketamine in migraine alleviation. However, within the last 20 years, the overall body of work addressing its role has not been clearly elucidated, with variations in optimal dosage and administration routes. Thus, this review aims to consolidate previous findings of ketamine as a migraine analgesic agent and to amass the most recent burgeoning data on its effectiveness in clinical settings. A comparison of intravenous, intranasal, and subcutaneous ketamine is examined, with a discussion on pharmacology, pharmacokinetics, and results in pain outcomes analyzed.