Migraine

The short version

●Migraine is a neurological disorder of recurrent moderate-to-severe headache, often one-sided and throbbing, with nausea, light/sound sensitivity, and sometimes aura — not "just a bad headache."
●It exists on a spectrum from episodic to chronic migraine (headache on 15+ days/month) and is a leading cause of disability worldwide.
●Migraine is strongly, bidirectionally linked with depression and anxiety — each roughly doubles the risk of the other — so the two are commonly treated together.
●Treatment has two arms: acute (triptans, gepants, NSAIDs) and preventive (CGRP monoclonal antibodies and gepants, certain antidepressants, anticonvulsants, beta-blockers, Botox for chronic migraine).
●Ketamine is not a standard migraine treatment; there is preliminary evidence for IV ketamine in refractory chronic migraine/status migrainosus in specialist settings, but it is not first-line.
●Ketamine's clearer relevance for migraine patients is the comorbid treatment-resistant depression that frequently accompanies chronic migraine.

Clinical definition

Migraine is a common, often disabling primary headache disorder characterized by recurrent attacks of moderate-to-severe head pain — frequently unilateral, pulsating, and aggravated by activity — lasting 4-72 hours and accompanied by nausea and/or sensitivity to light and sound. About a third of people with migraine experience aura: transient, usually visual neurological symptoms before or during the headache. Migraine is classified as episodic or chronic, the latter defined as headache on 15 or more days per month (with migraine features on at least 8) for more than three months. Its pathophysiology involves the trigeminovascular system and CGRP signaling with cortical and brainstem changes — it is a neurological disorder, not a sign of weakness. Migraine is among the leading causes of disability worldwide and is strongly comorbid with depression and anxiety, in a bidirectional relationship where each condition increases the risk and worsens the course of the other.

How it differs from related conditions

vs. Tension-type headache

More diffuse, pressing, and milder, without the nausea, light/sound sensitivity, or disability typical of migraine.

vs. Cluster headache

Severe, strictly one-sided headaches in clustered bouts with autonomic features (tearing, nasal congestion); distinct from migraine.

vs. Medication-overuse headache

Frequent use of acute headache medications can itself drive chronic daily headache — a common, reversible complication of migraine.

vs. Depression / anxiety

Not headache disorders, but so commonly comorbid with migraine that screening and joint treatment are standard.

First-line treatments

Acute treatments

Triptans, gepants (ubrogepant, rimegepant), NSAIDs, and antiemetics to stop attacks — used carefully to avoid medication-overuse headache.

Preventive medications

CGRP monoclonal antibodies and gepants, plus older options (topiramate, beta-blockers, amitriptyline, candesartan); onabotulinumtoxinA (Botox) for chronic migraine.

Treating comorbid depression/anxiety

Certain agents (amitriptyline, venlafaxine) treat both migraine and mood; integrated care improves both.

Lifestyle and trigger management

Regular sleep, hydration, meals, stress management, and limiting acute-medication frequency.

When standard treatments fail

When acute and preventive treatments fail, the steps are to confirm adherence and adequate trials, screen for and treat medication-overuse headache (a common, reversible cause of refractoriness), optimize CGRP-targeted and other preventives, treat comorbid depression and anxiety, and refer to headache specialty care. For truly refractory chronic migraine or status migrainosus, specialist centers sometimes use inpatient protocols that can include intravenous ketamine — an area of preliminary evidence, not established first- or second-line care.

Where ketamine fits

Ketamine is not a standard migraine treatment. There is preliminary evidence — largely from refractory chronic migraine and status migrainosus treated in specialist inpatient settings (Pomeroy 2017) — that IV ketamine can reduce pain in patients who have exhausted standard options, but this is not established care, and the modern migraine-preventive landscape (CGRP therapies, Botox) should be optimized first. Ketamine's clearer relevance for migraine patients is the comorbid treatment-resistant depression that so commonly accompanies chronic migraine: that depression is a legitimate ketamine indication, and treating it can improve overall burden. Tovani frames ketamine for migraine honestly — relevant mainly to the mood comorbidity, not as a primary migraine therapy.

Where this fits with Tovani

Tovani's role for migraine patients is the frequently co-occurring treatment-resistant depression, not migraine itself, which is best managed by primary care or headache specialists with modern acute and preventive therapies. Eligibility screening captures headache burden, current migraine care, and mood. Patients seeking ketamine specifically for migraine are directed first to optimize CGRP-targeted and other established treatments with a headache specialist; where a treatment-resistant depression coexists, ketamine for the depression is appropriate.

Check eligibility Find treatment options The science behind ketamine

Frequently asked

Can ketamine treat my migraines?

It is not a standard migraine treatment. There is only preliminary evidence for IV ketamine in refractory chronic migraine or status migrainosus in specialist settings, and modern preventives (CGRP therapies, Botox) should be optimized first. Ketamine's clearer role for migraine patients is treating a co-occurring treatment-resistant depression.

Why are migraine and depression connected?

They're bidirectionally linked — each roughly doubles the risk of the other, and they share biology. That's why screening for and treating both together is standard, and why some medications (like amitriptyline) target both.

My migraines stopped responding to my medications — what now?

A key, often-missed cause is medication-overuse headache from frequent acute-medication use. Beyond that, a headache specialist can optimize CGRP-targeted preventives and Botox for chronic migraine. Refractory cases are managed in specialty care.

Does Tovani treat migraine?

Tovani treats the depression that frequently accompanies chronic migraine, not migraine itself. Migraine is best managed by primary care or a headache specialist; if a treatment-resistant depression coexists, ketamine for that is appropriate.

References

Petersen AS et al. 2024, The Lancet Neurology — Review of recent advances in diagnosing, managing, and understanding migraine, including modern preventive therapies. (PMID 38876749)
Pomeroy JL et al. 2017, Headache — Study of ketamine infusions for treatment-refractory headache — the preliminary evidence base for ketamine in refractory migraine. (PMID 28025837)
Murrough JW et al. 2013, American Journal of Psychiatry — Ketamine RCT in treatment-resistant depression, the comorbidity most relevant to migraine patients. (PMID 23982301)

Last reviewed by Dr. Ben Soffer, DO on May 31, 2026. This page is educational and not a substitute for clinical evaluation. A physician determines whether ketamine therapy is appropriate for your specific situation.