Ketamine for Chronic Migraine in Baltimore
When CGRP, Botox, and preventives haven't been enough.
Chronic migraine treatment in Baltimore with IV ketamine costs $1,499.99 per session ($1,125 for Vitality Circle members — a $374.99 saving) and is anesthesiologist-led care, under the medical direction of Dr. Brijen Joshi MD, a board-certified Johns Hopkins anesthesiologist. This off-label IV infusion targets central sensitization and cortical spreading depression — the neurological mechanisms driving refractory attacks that standard preventives don't reach. We evaluate refractory chronic migraine patients — those still having 15+ headache days a month after CGRP antibodies (Aimovig, Ajovy, Emgality, Vyepti) and Botox — as an evidence-based next step, working alongside your neurologist or headache specialist rather than instead of them. Ketamine is not a cure and is not first-line — it is a conversation about whether NMDA receptor blockade fits your situation.
Mon–Fri 1PM–8PM · Sat 10AM–2PM
513 Bayview Blvd, Canton, Baltimore MD 21224
(443) 563-1059
Tell Us About Your Migraine History
Answer a few quick questions about your migraine history, preventives tried, and current frequency. Our clinical team reaches out within 1 business day.
Your information is confidential. A clinical team member follows up within 1 business day.
You've Done Everything — And It Still Isn't Enough
If this is your story, you are part of a defined refractory population. About 3.2 million Americans live with chronic migraine — 15 or more headache days per month — and a meaningful subset have failed every FDA-approved preventive class. This is not because you've done something wrong. It's because chronic migraine is driven by progressive central sensitization in the trigeminal system, and not every patient's nervous system responds to the same mechanisms. Different mechanism, different chance of response.
At Vita Nova, we evaluate refractory chronic migraine patients for IV ketamine infusion — an off-label, evidence-based intervention that targets central sensitization directly through NMDA receptor blockade. We work alongside your neurologist or headache specialist, not in place of them. The conversation is honest. The gatekeeping is real. And if it isn't a fit for you, we'll say so.
What "Refractory" Means — The Defined Clinical Criteria
Unlike fibromyalgia, where refractory has no consensus definition, refractory chronic migraine has formalized criteria. The European Headache Federation 2020 criteria — widely adopted by the American Headache Society and headache specialty programs — define refractory chronic migraine as:
If you meet these criteria — or close to them — you are part of the refractory population for whom ketamine evaluation may be appropriate. If you haven't yet completed adequate trials of CGRP or Botox, your neurologist should be your next call. We say this because honest gatekeeping protects you from pursuing an off-label treatment when a covered, evidence-strong option hasn't been fully tried yet.
We Work With Your Neurologist — Not Around Them
Baltimore has world-class headache neurology programs — the Johns Hopkins Headache Center, the University of Maryland Neurology service, and MedStar Neurology. If you have refractory chronic migraine, you should be seeing one of these specialists. They are the experts in headache medicine. We are not a replacement.
Vita Nova's Role: Outpatient IV Ketamine Partner
If you are already under the care of a headache neurologist at Hopkins, University of Maryland, MedStar, or a community headache specialist — and they have tried what's available without enough relief — Vita Nova provides the outpatient IV ketamine infusion service that headache neurology programs do not typically operate in-house. We coordinate with your existing physician throughout, share records both directions, and make no changes to your preventive or acute regimen without their input. The headache neurologist remains your primary headache physician. We are the IV ketamine arm.
If you don't yet have a headache neurologist, we recommend establishing care with one before pursuing ketamine evaluation. Refractory chronic migraine is a neurological subspecialty, and the long-term relationship matters — ketamine is one piece of a larger care picture.
FDA-Approved Migraine Treatments — The Pathway Before Ketamine
Chronic migraine has more FDA-approved preventive treatment options than almost any other chronic pain condition. These must be explored with your neurologist before ketamine evaluation.
Your neurologist or headache specialist should be your first call. Ketamine is evaluated after these approaches have not been enough.
Erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), eptinezumab (Vyepti). Monthly or quarterly injections targeting CGRP — the dominant neuropeptide in migraine pathophysiology. First-line modern preventives. Often covered by insurance.
Rimegepant (Nurtec ODT) and atogepant (Qulipta) for prevention; rimegepant and ubrogepant (Ubrelvy) for acute attacks. Useful for patients with cardiovascular contraindications to triptans.
Quarterly injections across 31 sites. FDA-approved specifically for chronic migraine (15+ headache days/month). Often covered by insurance. Given by neurologists or headache specialists.
Topiramate, valproate, beta-blockers (propranolol), tricyclics (amitriptyline) for prevention. Triptans for acute treatment. Often tried first due to cost or insurance step requirements.
Medication Overuse Headache — When Treatment Becomes the Problem
Medication overuse headache (MOH) affects an estimated 1–2% of the general population and is extremely common among chronic migraine patients. It must be identified before ketamine evaluation because it directly affects treatment planning.
When acute headache medications are used too frequently, they paradoxically cause more frequent headaches — the medication intended to relieve migraine ends up perpetuating it. MOH develops through opioid receptor sensitization and NMDA receptor upregulation. The result is a self-reinforcing cycle: more headaches, more medication, worse headaches.
MOH thresholds — use beyond these frequencies risks rebound headache:
If MOH is identified at evaluation, it affects ketamine treatment planning. Supervised medication withdrawal — coordinated with your neurologist — is typically needed before or alongside ketamine therapy. Ketamine's NMDA mechanism may help address the receptor upregulation component, but withdrawal management is a neurology decision.
The Chronification Process — Why Migraines Stop Responding
Understanding how episodic migraine becomes chronic explains why ketamine's NMDA mechanism is relevant to refractory patients. Migraine starts discrete and ends up self-sustaining.
Migraine begins as discrete attacks (typically 4–72 hours) with complete recovery between episodes. NMDA receptors are at baseline excitability. Attacks are often predictable and triggered by identifiable factors.
With each migraine, the trigeminal nucleus caudalis and higher-order pain centers are activated. Over months to years, NMDA receptors become progressively sensitized — lowering the threshold for subsequent attacks. Interictal periods shrink. Allodynia develops.
Once central sensitization is established, migraine becomes self-sustaining — occurring 15+ days per month independently of peripheral triggers. The nervous system no longer needs a strong external trigger. Medication overuse accelerates the process through NMDA upregulation.
Ketamine's NMDA receptor blockade targets the mechanism sustaining chronic migraine — NMDA hyperexcitability in trigeminal and supraspinal pain centers. A series of infusions may reset excitability thresholds, addressing the central sensitization that has made attacks self-sustaining.
How Ketamine Addresses Chronic Migraine — CSD & Central Sensitization
Ketamine's relevance to chronic migraine operates through two distinct but related NMDA-mediated mechanisms.
- CSD is a slowly propagating wave of neuronal depolarization across the cerebral cortex — it underlies migraine aura and triggers the trigeminovascular pain cascade.
- CSD propagation is mediated through NMDA receptor activation — as the depolarization wave spreads, glutamate is released, activating NMDA receptors that perpetuate the spreading.
- Ketamine's NMDA blockade may interrupt CSD propagation — preclinical research has demonstrated NMDA antagonist suppression of CSD in animal models.
- This mechanism is the basis for IV ketamine's acute use in status migrainosus — to interrupt the self-sustaining activation cascade when standard treatments have failed.
- Progressive NMDA receptor hyperactivity in the trigeminal nucleus and pain centers lowers the migraine threshold with each attack — the mechanism of chronification.
- Burstein R et al. (2000, Annals of Neurology) documented central sensitization during migraine attacks — with allodynia as the clinical marker that makes attacks resistant to triptans.
- Ketamine's NMDA blockade directly targets the hyperexcitability sustaining central sensitization — the same mechanism relevant to fibromyalgia, CRPS, and other central pain conditions.
- A series of infusions may allow the sensitized trigeminal system to reset toward more normal excitability thresholds — reducing migraine frequency from the inside.
References: Burstein R et al. (2000). An association between migraine and cutaneous allodynia. Ann Neurol 47(5):614-24. PubMed · Ayata C, Lauritzen M (2015). Spreading depression, spreading depolarizations, and the cerebral vasculature. Physiol Rev 95(3):953-93. PubMed · Cohen SP et al. (2018). ASRA/AAPM/ASA consensus guidelines on IV ketamine infusions for chronic pain. Reg Anesth Pain Med 43(5):521-46. PubMed
Response Rates & Status Migrainosus — Both Halves of the Story
The evidence for ketamine in refractory chronic migraine is meaningful but not definitive. We tell you the response rates upfront.
Inpatient continuous IV ketamine for refractory headache: Schwenk et al. (Thomas Jefferson University, Regional Anesthesia and Pain Medicine, 2018) reviewed 61 patients admitted for 5 days of continuous IV ketamine. Forty-eight (77%) responded in hospital — a 2-point or greater drop in pain — with maximum improvement around day 4.5. At follow-up, 40% had kept that improvement at about 5 weeks and 39% at about 3 months. Adverse events were mild and equally common in responders and non-responders.
What this means: Roughly three in four patients see short-term improvement; about four in ten sustain it past a month. About one in four sees no benefit at all — and this was an inpatient continuous-infusion protocol, so outpatient results may differ. These are real numbers, not marketing numbers. If you pursue ketamine evaluation at Vita Nova, we'll tell you during and after induction whether you're responding. If you're not, treatment isn't continued indefinitely.
Retrospective analysis of 61 refractory headache patients admitted for 5 days of continuous IV ketamine at Thomas Jefferson University. 77% were immediate responders; 40% sustained the improvement at about 5 weeks and 39% at about 3 months. Adverse events were mild. The same group's earlier series (Pomeroy et al., Headache 2017) reported similar short-term benefit. Together they are the clearest published response-rate data for ketamine in refractory migraine — and they show why maintenance and honest response assessment matter.
Documented cutaneous allodynia during migraine attacks in 79% of the migraine patients studied. Central sensitization developed within the first hour of attack and, once established, made attacks unresponsive to triptan treatment. Established central sensitization as a clinically and therapeutically significant feature of migraine.
Comprehensive review of cortical spreading depression establishing its role in migraine aura and trigeminovascular activation. Documented that NMDA receptor activation is essential to CSD propagation and that NMDA antagonists suppress CSD — providing the mechanistic foundation for ketamine's relevance to the CSD component.
Review of the transformation model of migraine: patients move between no migraine, low- and high-frequency episodic migraine, and chronic migraine (15+ headache days a month), with population studies estimating that episodic migraine transitions to chronic migraine at about 2.5% per year. Modifiable risk factors identified across this literature include attack frequency, medication overuse, obesity, depression, and cutaneous allodynia — the epidemiological basis for treating chronic migraine as a progression driven by central sensitization.
Status Migrainosus — The Strongest Acute Indication
Status migrainosus is a debilitating migraine attack lasting more than 72 hours — unresponsive to standard acute medications including triptans, NSAIDs, antiemetics, and steroids. It is a neurological emergency that frequently results in emergency department visits and hospital admission.
Published case series and headache unit reports document IV ketamine successfully terminating refractory status migrainosus when standard treatments have failed. Patients who had failed parenteral triptans, IV valproate, IV prochlorperazine, dexamethasone, and IV magnesium have responded to subanesthetic ketamine infusion. The mechanism involves ketamine's NMDA blockade interrupting both the central sensitization loop maintaining the prolonged attack and the CSD propagation component.
Important clarification: Vita Nova is an outpatient infusion clinic, not an emergency department. We do not provide acute status migrainosus rescue treatment. We do evaluate patients with a history of recurrent status migrainosus for ongoing central sensitization-resetting infusion therapy — with the goal of preventing future refractory episodes. If you are currently in a status migrainosus attack, contact your headache neurologist's on-call line or go to the emergency department.
The Clinical Protocol — What Treatment Looks Like
Your Care Pathway
Consultation — conversation about your migraine history, CGRP/Botox trials, current frequency, medication use. No commitment.
Clinical evaluation — physician review of records, MOH screening, neurologist coordination, candidacy assessment, informed consent.
Induction series — 5 daily infusions over 1 week. Response is assessed during and after.
Maintenance & coordination — if you respond, booster infusions on an individualized schedule. Your neurologist receives updates throughout.
If you don't respond — we say so. Treatment isn't continued indefinitely. We hand back to your neurologist for next-line planning.
Who Ketamine Evaluation May Help — And Who Shouldn't Pursue It
Honest gatekeeping is part of how we treat refractory migraine patients. Not everyone is a candidate.
✓ Likely a Reasonable Candidate
- Confirmed chronic migraine diagnosis (15+ headache days/month)
- Established care with a neurologist or headache specialist
- Documented trial of CGRP monoclonal antibody and/or Botox without adequate response
- Documented trial of at least one oral preventive class
- Free from medication overuse, or actively managing it with your neurologist
- Maryland resident, able to attend daily infusions for 1 week in Canton, Baltimore
⚠ Should Not Pursue Without Further Workup
- No confirmed migraine diagnosis yet — see a neurologist first
- Have not tried CGRP, Botox, or established oral preventives
- Uncontrolled hypertension or significant cardiovascular disease
- Increased intracranial pressure or recent head injury without neurology clearance
- Active untreated psychosis, mania, or substance use disorder
- Pregnancy or breastfeeding
- Currently in an acute status migrainosus attack (go to ED instead)
Final candidacy is determined by clinical evaluation. Not all patients who complete evaluation are offered treatment.
Your First Session — Step by Step
Check-In & Vital Signs
You arrive at 513 Bayview Blvd in Canton, Baltimore. Parking is free. You're shown to a private infusion room. Vital signs — blood pressure, heart rate, oxygen saturation — are taken before the infusion starts.
IV Placement & Settling In
An IV line is placed. You sit in a reclining chair with a blanket, dim lighting, and the option of an eye mask or music. Migraine patients often appreciate the dark, quiet environment. Clinical staff remain available throughout.
40-Minute Infusion
The ketamine infusion runs over 40 minutes at sub-anesthetic dose. You may feel mild dissociation — a sense of being slightly outside yourself. Some find it interesting, some neutral. The effect is dose-related and well-controlled. Vital signs monitored continuously.
15–30 Minute Recovery
Dissociative effects fade rapidly after infusion ends. You rest until you feel clear and steady. Light nausea is occasional and managed.
Ride Home Required
You cannot drive yourself. Arrange rideshare, family, or a friend. Plan to rest the remainder of the day. Avoid driving, machinery, legal documents, or significant decisions until the following morning. Daily sessions for 5 days require planning — many patients arrange a week off work.
Physician-Led Care — Dr. Brijen L. Joshi MD
IV ketamine for refractory chronic migraine is a medical procedure. At Vita Nova, it is physician-led under the medical direction of Dr. Brijen L. Joshi MD — a board-certified anesthesiologist with an active Johns Hopkins faculty appointment. Anesthesiology is the medical specialty most directly trained in IV anesthetic dosing, sub-anesthetic titration, and physiological monitoring during dissociative drug effects — the exact skill set a monitored ketamine infusion calls for. This is physician-led care, not a nurse-only or spa drip.
Dr. Joshi is a board-certified anesthesiologist and Assistant Professor of Anesthesiology & Critical Care Medicine at Johns Hopkins University School of Medicine. He brings deep training in IV anesthetic dosing, intraoperative vital-sign management, and the clinical use of dissociative agents. He coordinates with referring neurologists throughout the care pathway.
Migraine Ketamine Pricing at Vita Nova
Chronic migraine ketamine therapy is off-label. Pricing is per session; a standard outpatient induction is five daily sessions over one week, set individually at evaluation. HSA and FSA cards are accepted, and Community Heroes discounts apply.
| Service | Non-Member | Vitality Circle Member | Saving |
|---|---|---|---|
| Ketamine — Chronic Pain / session Off-Label | $1,499.99 | $1,125 | $374.99/session |
If you have co-occurring depression or fibromyalgia: roughly 30% of chronic migraine patients also live with fibromyalgia, and depression is highly comorbid. These overlapping conditions are driven by the same NMDA-receptor and descending pain-inhibition pathways ketamine targets for migraine — which is why a single evaluation considers your whole pain picture. See our co-occurring depression & chronic pain page.
Self-pay, with a superbill. Vita Nova is self-pay for ketamine. Each $1,499.99 session is a private, continuously monitored infusion under the medical direction of Dr. Brijen L. Joshi MD, a board-certified Johns Hopkins anesthesiologist — physician-led care throughout. Vitality Circle membership ($99.99/month) lowers each session to $1,125; the $374.99 saved covers the membership on a single visit, and members also receive 25% off premium IVs (NAD+, high-dose Vitamin C, Iron) plus one included monthly perk (1 standard IV drip, 2 IM shots, 2 IV pushes, or 1 shot + 1 push). We provide an itemized superbill you can file with your insurance. HSA/FSA accepted; Community Heroes discounts available. Number of sessions determined individually at evaluation. Pricing August 2026 — subject to change. Full pricing guide →
Complementary Treatments — Not Replacements
Several wellness services have independent migraine evidence or mechanistic relevance. These are not migraine treatments and are not part of our ketamine clinical protocols. Discuss with your neurologist.
Magnesium has independent migraine evidence. IV magnesium is used acutely to break attacks. Deficiency is documented in migraine patients. Magnesium also modulates NMDA receptor sensitivity relevant to ketamine's mechanism. American Headache Society includes magnesium in migraine guidance.
Riboflavin (B2) has independent prevention evidence — 400 mg daily reduced migraine frequency significantly in a placebo-controlled trial (Schoenen et al., Neurology 1998). B-Complex includes riboflavin alongside B12 supporting neurotransmitter synthesis and nerve function.
Iron-deficiency anemia is common in menstruating women — the group most affected by chronic migraine — and is linked to more frequent attacks and to the fatigue that undermines recovery. When bloodwork confirms deficiency, IV iron restores stores faster than oral supplements many patients tolerate poorly.
Neuroinflammation is increasingly recognized as a component of migraine pathophysiology. High-dose IV Vitamin C addresses oxidative stress and inflammatory signaling, complementing ketamine's central sensitization mechanism.
Mitochondrial dysfunction is documented in migraine — impaired neuronal energy production has been proposed as a contributor to cortical hyperexcitability and CSD susceptibility. NAD+ supports mitochondrial function.
Clinical note: These wellness services are not treatments for migraine. Always discuss supplemental therapy with your neurologist — particularly regarding interactions with topiramate, valproate, or CGRP medications.
Special Pricing for Those Who Serve
Chronic migraine disproportionately affects women and working-age adults — including nurses and healthcare workers whose irregular sleep, high stress, and demanding schedules are among the strongest migraine risk factors.
Ketamine for Chronic Migraine — Common Questions
Real questions from refractory chronic migraine patients evaluating ketamine and IV therapy in Baltimore.
A Conversation,
Not a Commitment
If CGRP, Botox, and oral preventives haven't been enough, the next step is talking with us. We review your full history, screen for medication overuse, coordinate with your neurologist, and tell you honestly whether ketamine evaluation is a reasonable next step — or whether it isn't. Off-label, self-pay with an itemized superbill you can file with your insurance.
Canonical URL: https://vitanovawellnessclinic.com/chronic-migraine-treatment-baltimore/ · Last reviewed August 26, 2026
Medically reviewed by Dr. Brijen L. Joshi MD — Assistant Professor of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine · Chief of Thoracic Anesthesia, Johns Hopkins Hospital · Medical Director, Vita Nova Ketamine & Wellness Clinic. · View full credentials →
