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Explore treatment options for chronic and difficult-to-treat migraines, including physician-supervised IV ketamine therapy for appropriately selected patients in Franklin, Nashville, and Middle Tennessee.
Migraine treatment generally combines acute therapy to control an attack with preventive treatment designed to reduce future attacks.
Treatment may include migraine-specific medications, preventive medications, CGRP-targeting therapies, onabotulinumtoxinA for appropriate chronic migraine patients, behavioral and lifestyle strategies, and other specialist-directed treatments.
For selected patients whose migraines remain frequent, disabling, or difficult to control despite appropriate conventional care, a clinician may consider additional approaches, including off-label IV ketamine therapy.
Migraine is a neurological disorder—not simply a severe headache. Attacks can include throbbing or pulsating head pain, nausea, vomiting, fatigue, and sensitivity to light, sound, or smells. For some people, migraine becomes frequent enough to interfere with work, relationships, sleep, and everyday activities.
The International Classification of Headache Disorders defines chronic migraine as headache occurring on 15 or more days per month for more than three months, with migraine features on at least eight days per month. Review the International Headache Society criteria .
Frequency is only one part of the picture. Even less frequent migraine attacks can be highly disabling. A medical evaluation considers attack pattern, severity, associated symptoms, treatments already tried, current medications, and the effect migraines are having on daily function.
There is no single migraine treatment that works for everyone. Care generally focuses on stopping or reducing an active attack while also decreasing the frequency, duration, or severity of future attacks.
Acute therapies are used after an attack begins. Depending on the individual, treatment may include over-the-counter medications, triptans, gepants, anti-nausea medicines, or other clinician-directed treatments.
Preventive care may include established oral medications, migraine-specific CGRP-targeting therapies, injectable treatments, and onabotulinumtoxinA for appropriate chronic migraine patients.
Consistent sleep, hydration, regular meals, exercise as tolerated, headache tracking, trigger awareness, and stress-management strategies can support a comprehensive migraine treatment plan.
Some people continue to experience severe or frequent migraines after trying multiple appropriate therapies. Difficult-to-treat cases may be described as refractory, intractable, or treatment-resistant migraine, although definitions can vary.
When treatment has not provided adequate relief, a clinician may reassess the diagnosis, review previous medications, evaluate possible medication-overuse headache, consider coexisting pain conditions, and determine whether additional specialist-directed approaches are appropriate.
This is the context in which IV ketamine has attracted clinical and research interest—not as a routine first-line migraine treatment, but as a potential option for selected patients with difficult-to-treat headache disorders when conventional approaches have been insufficient.
Ketamine is an anesthetic medication that affects N-methyl-D-aspartate (NMDA) receptors and other neural signaling systems involved in pain processing. Researchers have investigated these effects in several difficult-to-treat pain conditions, including refractory headache disorders and chronic migraine.
At Tennessee Ketamine & Wellness Center, IV ketamine is administered in a medically supervised clinical setting. TNKW evaluates migraine headaches among the chronic pain conditions for which ketamine therapy may be considered.
Patients interested in the treatment itself can learn more about IV ketamine therapy > and the ketamine treatment options available at TNKW.
Important: Ketamine is not FDA-approved specifically for migraine treatment. Its use for migraine is off-label. Whether ketamine is appropriate depends on an individualized medical evaluation, previous treatments, health history, potential risks, and available alternatives.
Research into ketamine for migraine is developing. Some studies involving highly treatment-resistant patients have reported reductions in headache pain, but the overall evidence remains limited. Findings from selected refractory patients should not be interpreted as proof that ketamine is effective for everyone with migraine.
A retrospective study involving patients with chronic migraine or new daily persistent headache who had already failed aggressive treatments reported lower average headache pain ratings following subanesthetic IV ketamine treatment. The authors called for controlled trials to better establish effectiveness.
View the study on PubMed →A systematic review found that available randomized evidence was limited and very low quality, with differences in ketamine routes, comparison treatments, and study outcomes. The authors concluded that additional controlled research is needed.
Read the systematic review →What this means for patients: Ketamine should not be presented as a migraine cure or guaranteed treatment. Some difficult-to-treat patients may experience benefit, while others may not. A medical consultation can help determine whether the potential benefits and uncertainties are reasonable for an individual patient.
Candidacy is individualized. A consultation may be appropriate for an adult with a documented migraine or chronic headache condition who continues to experience significant symptoms despite appropriate conventional treatment and whose medical history allows ketamine to be administered safely.
Ketamine is not appropriate for every patient. The decision to proceed should follow an individualized medical assessment rather than a diagnosis or previous treatment failure alone.
TNKW provides individualized IV ketamine treatment in a private, medically supervised clinical environment in Franklin. Treatment begins with a medical evaluation and is tailored according to health history, previous treatments, symptoms, and clinical goals.
Your medical history, headache pattern, previous therapies, current medications, and treatment goals are reviewed.
If ketamine is considered appropriate, the clinical team develops an individualized treatment and monitoring plan.
Treatment takes place in a clinical setting with continuous physiologic monitoring and experienced medical oversight.
Response, tolerability, function, and progress help guide subsequent treatment decisions.
Conveniently located in Franklin near Cool Springs, Tennessee Ketamine & Wellness Center serves patients exploring specialized migraine and chronic pain treatment options throughout Williamson County, Nashville, and surrounding Middle Tennessee communities.
Franklin
Brentwood
Cool Springs
Spring Hill
Thompson's Station
Nolensville
Nashville
Bellevue
Green Hills
Forest Hills
Oak Hill
South Nashville
Murfreesboro
Smyrna
Mount Juliet
Lebanon
Columbia
Fairview
1909 Mallory Lane, Suite 300
Franklin, TN 37067
615-813-5006
There is no single best treatment for every person. Chronic migraine care may combine acute medication, preventive therapy, migraine-specific CGRP treatments, onabotulinumtoxinA when appropriate, lifestyle strategies, and management of contributing factors. Treatment should be individualized according to attack frequency, disability, medical history, previous response, and patient preferences.
Under ICHD-3 criteria, chronic migraine involves headache on at least 15 days per month for more than three months, with migraine features on at least eight days per month.
A clinician can reassess the diagnosis, review previous treatments, evaluate medication overuse and coexisting conditions, and consider other preventive, procedural, behavioral, or specialist-directed options. Selected refractory patients may also discuss off-label treatments such as ketamine with an experienced physician.
Ketamine has been studied in migraine and refractory headache disorders, and some clinical reports describe benefit in selected difficult-to-treat patients. However, evidence remains limited. Ketamine is not FDA-approved specifically for migraine, so this use is off-label.
Ketamine blocks NMDA receptors and influences several neural signaling pathways involved in pain processing and central sensitization. These mechanisms are among the reasons researchers have investigated ketamine for refractory headache disorders, but its relationship to clinical migraine outcomes continues to be studied.
No. Established acute and preventive migraine treatments have substantially stronger evidence and are generally considered first. Ketamine is more appropriately discussed as a specialized, off-label option for selected difficult-to-treat cases.
No. Ketamine should not be described as a cure for migraine. Some patients in small or observational studies have experienced reductions in pain or headache burden, while others have not. More high-quality research is needed.
Potential candidates are evaluated individually. A clinician may consider diagnosis, migraine frequency and severity, previous treatment failures, current medications, other health conditions, and whether ketamine can be administered safely.
There is no universally established FDA-approved ketamine infusion protocol for migraine. Published studies have used different routes, doses, schedules, and treatment settings. An individualized plan should be determined by the treating physician.
Coverage varies by insurer and plan, and off-label IV ketamine treatment may not be covered. Patients should verify benefits and current costs before beginning treatment.
Tennessee Ketamine & Wellness Center evaluates patients at its Franklin, Tennessee clinic near Cool Springs, serving Nashville and surrounding Middle Tennessee communities. A medical consultation is the first step in determining whether ketamine may be appropriate.
Some headaches require urgent or emergency evaluation rather than an elective migraine consultation. Seek prompt medical care for a sudden severe or “worst” headache, a new severe headache with weakness, confusion, loss of consciousness, fever or stiff neck, a headache following significant head injury, or a major unexplained change in an established headache pattern.
If chronic or difficult-to-treat migraines continue to interfere with daily life despite conventional care, an individualized medical evaluation can help clarify what treatment options remain.
Request a Consultation Call 615-813-5006This educational resource provides general information about migraine, chronic migraine, available treatment approaches, and current research involving ketamine. It is not a substitute for individualized medical advice, diagnosis, or treatment. IV ketamine use for migraine is off-label. Treatment decisions should be made following evaluation by an appropriately qualified medical professional.