Beyond the Raskin Protocol: Ketamine, Lidocaine, and Other Therapies for Refractory Chronic Migraine

• Published in: Current pain and headache reports Vol. 25; no. 12; p. 77
• Main Authors: Mojica, Jeffrey J., Schwenk, Eric S., Lauritsen, Clinton, Nahas, Stephanie J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2021; Springer Nature B.V
• Subjects: Analgesics; Anesthesia; Anesthetic Techniques in Pain Management (D Wang; Anesthetic Techniques in Pain Management (D Wang, Section Editor); Disease prevention; Drug dosages; Failure; Hallucinations; Headaches; Humans; Hypertension; Internal Medicine; Ketamine; Lidocaine; Medicine; Medicine & Public Health; Migraine Disorders - drug therapy; Nausea; Pain management; Pain Medicine; Prospective Studies; Section Editor; Topical Collection on Anesthetic Techniques in Pain Management; Vomiting; Chronic migraine; Ketamine; Lidocaine; Raskin protocol; Refractory headache
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-021-00992-x

Purpose of Review
The purpose of this review is to discuss the available evidence and therapeutic considerations for intravenous drug therapy for refractory chronic migraine.
Recent Findings
In carefully monitored settings, the inpatient administration of intravenous lidocaine and ketamine can be successful in treating refractory chronic migraine.
Summary
Many patients with refractory chronic migraine have experienced treatment failure with the Raskin protocol. The use of aggressive inpatient infusion therapy consisting of intravenous lidocaine or ketamine, along with other adjunctive medications, has become increasingly common for these patients when all other treatments have failed. There is a clear need for prospective studies in this population comprised of patients who have largely been excluded from other studies.