Ketamine is a sedating agent used to induce anesthesia. It is also a drug of abuse with street names such as “Special K” or “Ket”.

Ketamine has many advantages, which makes it a very popular choice in anesthesia. It works fast, blocks pain, opens the lungs, it is easy on the heart, and has anti-inflammatory properties. It may also have anti-cancer properties. Ketamine is being extensively tested for the treatment of depression that does not respond to medications.

Because ketamine works on a receptor involved in transmitting pain messages in the brain (NMDA receptor), it has been studied in various painful conditions. The amounts being tested for pain are much smaller than those used to induce anesthesia or even those used recreationally.

Even though it is a drug of abuse, it appears to be less addictive than heroine and prescription narcotics.

There are only few small studies and reports about the use of ketamine for migraine headaches. One such report published in the leading neurological journal Neurology describes 18 patients with prolonged migraine auras who were treated with intranasal ketamine spray. The duration of their auras was not shortened by ketamine, but the severity was reduced.

Another study showed that severe disabling aura was relieved in 5 out of 11 patients with hemiplegic migraine.

Several anecdotal reports have touted the benefits of ketamine in chronic migraines, cluster headaches, and chronic paroxysmal hemicrania (a rare type of headache that often responds to indomethacin and at times to Botox). While such anecdotal reports are useful, we need to have controlled trials to make sure that placebo effect is not playing a major role. There is nothing wrong with utilizing the placebo effect, but only if the treatment is completely benign. Unfortunately, ketamine like any other drug can have potentially serious side effects. This is why before treating pain with ketamine intravenously patients must be screened for possible heart disease or psychiatric disorders such as schizophrenia. While intranasal ketamine can be given in an office setting, intravenous administration must be done under close monitoring. Another issue is the cost since insurance companies do not cover this treatment because it is considered experimental.

There has been some backlash against meditation with newspapers publishing articles claiming that meditation is overrated. Fortunately, serious scientists continue to publish solid objective data proving that meditation not only relieves pain and headaches and makes you feel better, but in fact changes the structure of your brain. In my recent post I wrote about one such a study published in the Journal of Neuroscience.

A new rigorous scientific study was just published in Biological Psychiatry. It looked at the benefits of mindfulness meditation and how it changes people’s brains and potentially improves the overall health.

The study was conducted at the Health and Human Performance Laboratory at Carnegie Mellon University.

The researchers recruited 35 unemployed men and women who were looking for work and were under significant stress. Half of the people were taught mindfulness meditation at a residential retreat center, while the other half were provided sham mindfulness meditation, which involved relaxation and distraction from worries and stress.

All participants did stretching exercises, but the mindfulness group was asked to pay attention to bodily sensations, including unpleasant ones. The relaxation group was encouraged to talk to each other and ignore their bodily sensations.

After three days, all participants felt refreshed and better able to deal with the stress of unemployment. However, follow-up brain scans showed changes only in those who underwent mindfulness meditation. The scans showed more activity among the portions of their brains that process stress-related reactions and other areas related to focus and calm. By four months after the retreat most people stopped meditating, however the blood of those in mindfulness meditation group had much lower levels of interleukin-6, a marker of harmful inflammation, than blood of those in the relaxation group.

These changes occurred after only 3 days of meditation. It is likely that an ongoing meditation practice will produce stronger positive effects. Personally, I try to meditate 30 minutes on at least 5 days a week and this is what I recommend to my patients. Even 10 or 20 minutes can have an impact on migraine headaches and general well being.

There are several excellent resources for learning meditation. Free podcasts by a psychologist Tara Brach is an excellent resource. My favorite book to learn meditation is Mindfulness in Plain English by B. Gunaratana. And of course, there is an app for that – Headspace.com and Calm.com.

Prilosec (omeprazole), Nexium, Prevacid, and other similar drugs in the family of proton pump inhibitors (PPIs) can cause headaches directly, but more often by reducing the absorption of vitamins such as B12 and D, and minerals such as magnesium, over a longer period of time. My previous post described a 26,000 patient study that convincingly showed that PPIs cause vitamin B12 deficiency. We also know that older women on PPIs have a higher risk of bone fractures.

A report just published in JAMA Neurology adds another dangerous association. This was also a very large study that involved over 73,000 older people, of whom almost 3,000 were taking PPIs. Those on PPIs had a significantly higher risk of developing dementia. This is possibly due to a direct toxic effect of these drugs, but more likely it is because these drugs cause vitamin and mineral deficiencies.

Three month earlier, the same journal published a study that showed that low vitamin D levels are associated with a significantly higher risk of developing dementia. A very important finding of this study was that even those who had what is considered a normal vitamin D level of between 30 and 50 had an increased risk of dementia, compared with those whose level was above 50. This is not surprising because a study of multiple sclerosis (MS) showed that those with low normal levels had many more attacks of MS than those who had high normal levels. Vitamin D seems to protect from many other diseases and to prolong life.

Many doctors will often tell you that your vitamin D level is normal if it is above 30, but you should ask what your actual level is and try to get it up to at least into 40s or 50s. The upper limit of normal is 100 (level higher than 125 can be harmful). This may require you taking 5,000 or more a day. Our government’s recommended daily requirement of 600 units is insufficient for most people. The same applies to vitamin B12 – many labs will consider a level between 200 to 1,100 to be normal, but in fact it should be at least 400.

If you take PPIs, try to get off them, which is not an easy task. Stopping such drug causes “rebound” increase in acid secretion, which makes symptoms worse than they were before PPI was started. The way to do it is to switch ot Zantac or Pepcid with antacids taken as needed. Then, you try to stop Zantac and keep taking antacids. After a while, with proper diet, you may be able to stop antacids as well.