A randomized controlled trial of ketorolac for prevention of headache related to electroconvulsive therapy

Background and Purpose: Headache is one of the most common side effects of electroconvulsive therapy (ECT), with a reported prevalence as high as 45%. Typical pharmacologic measures include aspirin, acetaminophen, or nonsteroidal anti-inflammatory medications. Among the latter, ketorolac may be especially advantageous in that it can be administered intravenously right before a treatment. The primary aim of this study was to measure the efficacy of intravenous ketorolac administration for the prevention of post-ECT headache at the first treatment session. Methods: Sixteen patients were assigned to the control group, while eight patients were assigned to the ketorolac treatment group (8 males, 16 females; mean age ± standard deviation = 46 ± 13.5 years). Statistical analysis consisted of a one-way analysis of variance using the two-sample test. We utilized a post-ECT headache severity scale from zero (no headache) to 3 (severe headache). Results: The mean score for the control group was 1.3 (±1.1), while the mean score for the ketorolac treatment group was 1.2 (±1.1), p = 0.86 (not significant). Conclusions: Ketorolac administration does not decrease the incidence of post ECT headache at the first treatment session. It is possible that ketorolac may be effective at subsequent treatments for patients with particularly bothersome headaches after the first treatment. Implications: Ketorolac should not be routinely used at the first treatment session to prevent headache associated with ECT.