Traumatic Brain Injury: Can Ketamine Therapy Help?

Traumatic brain injury (TBI), including concussions, are a significant public health issue affecting millions globally each year. Although many patients recover on their own, a significant number experience persistent symptoms, such as post-traumatic headaches, sleep disturbances, cognitive impairment, depression, and post-traumatic stress disorder (PTSD). Given the limited effectiveness of traditional treatments, IV Ketamine holds promise for providing valuable symptom relief, especially when combined with the Stellate Ganglion Block (SGB).

Post-Traumatic Headaches (PTH) after TBI

Post-traumatic headaches is one of the most common complications following TBI. These headaches typically manifest within days of injury and can persist for months to years, significantly impairing quality of life. These post-TBI headaches appear to result from neurovascular inflammation, central sensitization, and cortical spreading depression (CSD), which can perpetuate chronic headache disorders.

CSD occurs after traumatic brain injury (loss of blood flow, trauma, etc.) where the vital chemicals responsible for proper neuron functioning become dysregulated. Neuroscientists refer to this as a collapse of electrochemical membrane gradients, which leads to loss of electrical signaling, excessive calcium loading in cells, cellular swelling, and dysregulated release of neurotransmitters. This is believed to be a major source of "excitotoxic injury," meaning nerve injury occurring because of hyperactivated nerve activity, which occurs through the NMDA receptor.

Ketamine for Treatment of Post-Traumatic Headaches

Ketamine is an anesthetic medication that blocks the NMDA receptor in your brain and central nervous system. Ketamine modulates activity of an excitatory neurotransmitter called glutamate. Ketamine also has anti-inflammatory effects and reduces cortical spreading depression. These key benefits of ketamine may explain its effectiveness in reducing headache and migraine severity after TBI, including those with aura.

Notably, ketamine inhibits release of numerous proinflammatory cytokines after nerve injury, including tumor necrosis factor α (TNF-α), IL-6, and IL-8. Ketamine also inhibits HMGB-1 activation, which is a critical cascade of endothelial inflammation, which is elevated in patients after TBI. Notably, patients with higher HMGB-1 activation have lower survival.

Ketamine also reduces the complications of central sensitization that may worsen headaches in patients with TBI.

Clinical evidence supports the efficacy of ketamine in treating severe and chronic migraine headaches, especially in cases resistant to standard treatments.

Sleep Disturbances after TBI

Sleep disturbances, including insomnia, fragmented sleep, nightmares, and disrupted REM cycles, are frequently reported post-TBI. These sleep disruptions exacerbate cognitive deficits and emotional disturbances, further complicating recovery. Neuroinflammation and disrupted neuronal networks are believed to contribute to these sleep disturbances.

Ketamine for Sleep Disturbances after TBI

Ketamine's effectiveness in improving sleep architecture and duration is well recognized in patients being treated with depression. This is believed to be through:

• Neurocognitive effects
• Anti-depressant benefits
• Improvements in anxiety
• Relief of co-morbid PTSD symptoms
• Circadian rhythm restoration

Ketamine's improvement with sleep appears related to its increased "deep sleep" duration (called slow-wave sleep) and enhancement of BDNF, or the "fertilizer of the brain."

Ketamine for TBI-associated PTSD

PTSD commonly co-occurs with TBI. Both TBI and PTSD are characterized by "synaptic loss," or disconnection of nerve transmissions. Both conditions also share neuroinflammation and anxiety, which is addressed with ketamine. Importantly, ketamine's potent neuroplasticity effects, through BDNF enhancement, appear to help both of these conditions.

Additionally, ketamine supports the growth of neurons in the hippocampus, which are hurt by the complications of TBI.

There is appreciable evidence of ketamine's benefits in PTSD. Given the paramount importance of treating PTSD in patients with TBI, and the lack of effective treatment options, ketamine's joint benefits is important to recognize.

TBI-associated Depression and Cognitive Impairment: Ketamine's role

Depression and cognitive impairment are frequent and debilitating complications of TBI. Ketamine, beyond its antidepressant effects, specifically targets cognitive symptoms associated with depression. Interestingly, some of ketamine's pro-cognitive effects are independent of antidepressant response.

‍Preclinical studies have supported the pro-cognitive effects of ketamine after brain injury.

These improvements in cognitive functioning significantly enhance the recovery trajectory and quality of life for TBI patients suffering from depression and cognitive deficits.

Seeking Help for TBI Complications

Traumatic brain injury presents complex therapeutic challenges, often complicated by overlapping conditions such as PTSD, depression, headaches, and persistent cognitive impairment. Emerging evidence strongly supports the use of IV Ketamine and stellate ganglion blocks (SGB) as promising modalities to address these challenging complications. Both therapies demonstrate rapid and sustained efficacy in reducing headaches, improving sleep, alleviating PTSD symptoms, and enhancing cognitive and emotional functioning in TBI patients. Schedule a free consultation with Clarus Health to learn if IV Ketamine may be effective in supporting your recovery from traumatic brain injury.