Migraine sufferers know the drill better than anyone. You find something that works, you rely on it, and then one day it stops working as well as it used to. Or you take medication so often that the medication itself starts causing headaches. Or you go through the cycle of neurology appointments, preventive prescriptions, and lifestyle changes, and your frequency barely budges. It is exhausting in a way that is hard to explain to someone who has never had to cancel plans, pull over on the highway, or lie in a dark room for two days because of a headache that does not respond to anything in the medicine cabinet.
Ketamine infusion therapy is not another medication layered on top of the ones that already are not cutting it. It works through a completely different mechanism, one that targets the neurological environment in which migraines occur rather than attempting to block an individual episode after it starts. For patients with chronic or refractory migraines, that distinction matters enormously. At Florida Regional Pain Management, PA, Dr. Shonith Manohar offers ketamine infusion therapy as part of a comprehensive, individualized approach to pain care that he has been developing and refining with Jacksonville patients since 2008.
The Real Reason Migraines Keep Coming Back
Migraines are not headaches that got out of hand. They are a neurological event driven by a cascade of brain activity that affects blood flow, electrical signaling, and the way sensory information is interpreted across the entire nervous system. For people who experience them frequently, the brain develops a kind of hair-trigger sensitivity over time, where it takes less and less stimulus to set off an episode. Bright light, a change in sleep, a skipped meal, a shift in barometric pressure. Things that would not register for most people send the migraine brain into a full response.
This is the piece that most treatments miss. Triptans are excellent at interrupting an episode that has already started, but they do not change the underlying excitability of the migraine brain. Preventive medications can raise the threshold, but many patients plateau or deal with side effects that make them hard to sustain long term. Ketamine targets the question of why the brain keeps becoming reactive in the first place.
What Ketamine Actually Does Differently
The mechanism behind ketamine’s effect on migraines centers on NMDA receptors, which are involved in how the brain amplifies and sustains pain signals. In migraine patients, these receptors contribute to a process called cortical spreading depression, a wave of altered brain activity that is closely linked to migraine onset and the development of aura. Chronic migraine sufferers often show evidence of central sensitization as well, meaning the brain’s pain-processing system has become broadly overreactive, not just locally sensitive.
Ketamine blocks NMDA receptor activity and simultaneously encourages the brain to build new neural pathways through neuroplasticity. The result is a genuine shift in how the brain is organized around pain and reactivity, not just a quieting of the current pain state. For many patients, this translates to fewer migraines, milder episodes, and a reduced dependence on abortive medications that have stopped working or were never fully effective.
Types of Migraines and Headache Conditions We Address
Ketamine therapy is not a universal fix for every type of headache, and Dr. Manohar will always take time to evaluate whether it is genuinely appropriate for your situation before recommending it. The patients who tend to see the strongest results are those with a clear neurological component to their migraine pattern and a history of incomplete response to conventional treatment. Conditions we commonly address with ketamine infusion therapy include:
- Chronic migraine, defined as 15 or more headache days per month
- Refractory migraine, meaning migraines that have not responded to multiple standard treatments
- Migraine with aura, particularly when neurological symptoms are prominent
- Medication overuse headache occurring as a result of frequent triptan or pain reliever use
- New daily persistent headache with migraine features
- Intractable migraine episodes that are severe and prolonged
If your headache pattern does not fit neatly into one of these categories, a consultation is still the right starting point. Dr. Manohar evaluates the full picture, not just the diagnosis on paper.
Are You the Right Candidate for Ketamine Migraine Treatment
The patients who benefit most tend to share a few things in common. They have been dealing with migraines long enough that a clear pattern has emerged, and that pattern has proven difficult to manage through standard channels. They want something that changes the underlying situation rather than just responding to it after the fact. You may be a strong candidate if you fit several of the following:
- Your migraines occur frequently enough to interfere with work, relationships, or daily function
- You have tried two or more preventive medications without achieving adequate control
- Triptans or other abortive treatments have become less effective or have stopped working
- You have developed medication overuse headache from relying too heavily on pain relievers
- Your migraines involve aura, prolonged neurological symptoms, or severe associated symptoms like vomiting and extreme light or sound sensitivity
- You want to reduce your overall dependence on medication and address the migraine pattern more directly
This list is a guide, not a gate. The consultation with Dr. Manohar is where the real determination gets made, based on your specific history and goals.
The Infusion Process at Florida Regional Pain Management
Ketamine therapy for migraines at our practice is not a quick-in, quick-out procedure. It is a supervised, personalized treatment experience that Dr. Manohar oversees directly. Before any infusion is scheduled, you will have a full consultation covering your migraine history, current and previous medications, and your goals for treatment.
Dosing is calculated individually based on your condition and health profile, not a standard protocol applied across the board. During each session, ketamine is delivered intravenously in a calm, controlled clinical environment. You stay conscious throughout, and the experience is often described as relaxed and mildly dreamlike. Our team monitors you directly and continuously from start to finish. A few practical things to know going in:
- Plan for each session to last roughly 40 minutes to a couple of hours depending on your protocol
- You will need a driver for every appointment without exception
- Avoid eating a heavy meal in the hours before each session
- For chronic migraine patients, a series of six infusions is the typical starting recommendation
- Dr. Manohar reviews your response after early sessions and adjusts the plan as needed before you finish the full series
- Some patients return for periodic maintenance infusions after completing their initial course
What Patients Notice, and What to Be Aware Of
Results with ketamine for migraines are not identical from person to person, but the pattern we see most consistently involves a gradual reduction in both frequency and intensity across a full infusion series. Some patients notice a difference after the second or third session. Others experience the clearest improvement once the complete series is finished and the brain has had time to consolidate the changes taking place. Common improvements include fewer migraine days per month, less severe episodes when they do occur, reduced reliance on triptans, and better overall function on days that would previously have been lost to pain and recovery.
In terms of side effects, the infusion itself can produce a temporary sense of dissociation, mild visual changes, or light nausea. These are well-understood effects of ketamine at therapeutic doses, they are not a cause for concern in a properly monitored setting, and they resolve once the infusion ends. Ketamine is not appropriate for all patients, which is why no treatment is scheduled before Dr. Manohar has reviewed your full medical picture and confirmed it is a safe and reasonable fit.
Your Migraines Have Taken Enough From You
Every migraine that sidelines you is a day, an event, an obligation you do not get back. If you have been managing around your migraines instead of managing them, it is time to have a different conversation. Dr. Manohar and the team at Florida Regional Pain Management, PA will evaluate your situation honestly and tell you whether ketamine infusion therapy is the right fit. Call us at (904) 737-7246 or request your consultation online today.
Frequently Asked Questions
Can ketamine help chronic migraines?
Yes. Ketamine is most often recommended for people with chronic or treatment-resistant migraines. By targeting how the brain processes pain, it may help reduce both the frequency and severity of migraines over time. During your consultation, Dr. Manohar will determine whether it’s a good fit for your condition.
Can I get ketamine if I'm already taking migraine medication?
In many cases, yes. Ketamine can often be used alongside preventive migraine medications, but we’ll review everything you’re taking before treatment begins. This helps ensure your treatment is both safe and effective.
How is ketamine different from other migraine treatments?
Most migraine medications are designed to stop or prevent individual attacks. Ketamine works differently by targeting the brain’s pain-processing pathways, which may help reduce how often migraines occur and how severe they become over time.
Can ketamine help with migraine symptoms besides head pain?
It may. Many patients report improvements in symptoms like nausea, light sensitivity, and sound sensitivity in addition to less severe headaches. Results vary, but the goal is to improve your overall migraine experience, not just the pain itself.
Can ketamine make migraines worse?
For most people, no. Ketamine is generally well tolerated when administered in a monitored medical setting. Some patients may experience a mild headache after treatment, but serious worsening of migraines is uncommon. We’ll review your medical history to make sure ketamine is appropriate for you.
What if Botox didn't help my migraines?
That doesn’t mean ketamine won’t. Botox and ketamine work in completely different ways, so not responding to one treatment doesn’t predict how you’ll respond to the other. Many people explore ketamine after other migraine therapies have provided limited relief.
How long does it take for ketamine to work for migraines?
Some people notice improvement after a few infusions, while others experience the greatest benefits after completing their full treatment series. Because everyone responds differently, Dr. Manohar will monitor your progress and discuss whether additional treatments may be beneficial.
Can ketamine help migraines and anxiety?
It can. Anxiety and migraines often occur together, and ketamine has also been studied for certain mood disorders. If you’re dealing with both, Dr. Manohar will consider your complete medical history when creating your treatment plan.
What our patients are saying
Everyone of the members of the staff and the doctor are totally awesome
Sandra M. | Nov 2023
I have been a patient for many years and have never had anything but top of the line care from my injections to regular follow up appointments both the doctor and all the staff is always friendly welcoming and helpful anytime I have needed to reschedule or make a change they have always gotten me t…
Allison D. | Oct 2022
I think dr. Manohar is very helpful, highly qualified and has a kind bedroom side manner. He is honest, knows his stuff, and is reassuring.