From the Guidelines
Ketorolac is effective for treating acute migraine attacks, but its use should be limited to 5 consecutive days due to potential side effects. According to the evidence from 1, ketorolac (brand name Toradol) can be administered as an intramuscular injection (30-60 mg), intravenous injection (15-30 mg), or oral tablet (10 mg). For migraine treatment, a single dose is typically used, with the injectable forms providing faster relief than oral tablets. Ketorolac works by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), which reduces prostaglandin production and decreases inflammation and pain associated with migraines.
Some key points to consider when using ketorolac for migraines include:
- It is particularly useful in emergency settings or when other treatments have failed
- It should be avoided in patients with kidney disease, history of peptic ulcers, bleeding disorders, or those taking blood thinners
- Common side effects include stomach upset, dizziness, and drowsiness
- For ongoing migraine management, preventive medications are recommended rather than repeated use of ketorolac
The evidence from 1 also highlights the importance of selecting a nonoral route of administration for patients whose migraines present early with nausea or vomiting as a significant component of the symptom complex, and treating nausea and vomiting with an antiemetic. Additionally, migraine sufferers should be evaluated for use of preventive therapy, and recommended first-line agents for the prevention of migraine headache include propranolol, timolol, amitriptyline, divalproex sodium, and sodium valproate.
It's worth noting that while ketorolac can be effective for treating acute migraine attacks, the evidence from 1, 1, 1, 1, 1, and 1 does not specifically mention ketorolac as a first-line treatment option, instead highlighting the use of other NSAIDs such as aspirin, ibuprofen, and naproxen sodium. However, based on the available evidence, ketorolac can be a useful option for treating acute migraine attacks, especially in emergency settings or when other treatments have failed.
From the Research
Effectiveness of Ketorolac for Migraines
- Ketorolac, a Nonsteroidal Anti-Inflammatory Drug (NSAID), has been studied for its effectiveness in treating migraines 2, 3, 4, 5.
- A study published in 2012 found that NSAIDs, including ketorolac, demonstrated some effectiveness in treating acute migraine, although they were inferior to the combination of metoclopramide and diphenhydramine 2.
- A prospective, randomized, double-blind trial in 1996 compared intramuscular ketorolac with intravenous chlorpromazine in treating acute migraine and found that ketorolac was as effective as chlorpromazine in reducing pain scores 3.
- Another study in 2000 reviewed the evidence regarding the effectiveness and safety of various therapies for migraine in the emergency department, including ketorolac, and found that prochlorperazine, chlorpromazine, and sumatriptan were the most effective agents 4.
- A controlled trial in 1998 found that intramuscular ketorolac was effective in short-term treatment of tension-type headache, with significant pain reduction at 0.5 and 1 hour compared to placebo 6.
- A quasi-experimental study in 2019 compared the therapeutic effects of a combination of metoclopramide + dexamethasone with those of ketorolac for treatment of acute migraine and found that both groups had similar pain reduction outcomes, although the pain reduction time was relatively shorter for ketorolac 5.
Comparison with Other Treatments
- Ketorolac has been compared to other treatments, including chlorpromazine, metoclopramide, and sumatriptan, with varying results 2, 3, 4, 5.
- A study found that ketorolac was arguably equivalent to meperidine and dihydroergotamine (DHE) in treating acute migraine, but was inferior to chlorpromazine and equivalent to other neuroleptics 2.
- Another study found that ketorolac was as effective as chlorpromazine in reducing pain scores, but with fewer side effects 3.