Ketamine and Lidocaine Infusion in Refractory Chronic Migraine

Inclusion Criteria: * All participants must fulfill the following inclusion criteria 1. medically stable outpatients with confirmed diagnosis of refractory chronic migraine according to American Headache society 2. Are reliable and willing to make themselves available for the duration of the study and are willing to follow up. 3. Men or women older than 18years of age. 4. clear written informed consent from each participant in the trial. 5. Adult patients with refractory migraine or refractory chronic migraine defined according to the American headache society Exclusion Criteria: 1. Pregnancy, active psychosis, liver disease, uncontrolled cardiac disease or cardiac rhythm abnormalities 2. presence of clinically significant medical or psychiatric condition that may increase the risk associated with the study 3. participation in any other type of medical research that may interfere with the interpretation of the study. 4. patients with hemocoagulation disorders, local infection or those who refused to consent