From the Guidelines
Ketorolac (brand name Toradol) 15mg injection can be effective for treating acute migraines, with a recommended dose of 15-30mg as a single intramuscular or intravenous injection, not to exceed 5 days of use. The medication works by blocking pain-inducing chemicals called prostaglandins, reducing inflammation and pain associated with migraines 1. Common side effects include stomach discomfort, dizziness, and drowsiness. This medication should be avoided in patients with kidney problems, history of stomach ulcers, bleeding disorders, or those taking blood thinners, and it's also not recommended during pregnancy, especially in the third trimester 1.
Some key points to consider when using ketorolac for migraines include:
- The medication should be used for the shortest duration possible to minimize the risk of side effects 1
- Patients should be monitored for signs of gastrointestinal bleeding, renal impairment, and other potential side effects 1
- Ketorolac may interact with other medications, such as blood thinners and certain antidepressants, which can increase the risk of side effects 1
- For ongoing migraine management, preventive medications and lifestyle modifications are usually more appropriate than repeated use of ketorolac 1
It's essential to weigh the potential benefits and risks of using ketorolac for migraines and to consider alternative treatment options, such as triptans or ergotamines, which may be more effective for some patients 1. Ultimately, the decision to use ketorolac for migraines should be made on a case-by-case basis, taking into account the individual patient's medical history, symptoms, and treatment goals.
From the FDA Drug Label
KETOROLAC TROMETHAMINE INJECTION Ketorolac tromethamine injection may be used as a single or multiple dose on a regular or “prn” schedule for the management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting.
Multiple-Dose Treatment (Intravenous or Intramuscular) Patients <65 years of age: The recommended dose is 30 mg ketorolac tromethamine injection every 6 hours. The maximum daily dose for these populations should not exceed 120 mg For patients ≥65 years of age, renally impaired patients (see WARNINGS), and patients less than 50 kg (110 lbs): The recommended dose is 15 mg ketorolac tromethamine injection every 6 hours. The maximum daily dose for these populations should not exceed 60 mg.
The FDA drug label does not mention migraine as an indication for ketorolac tromethamine injection. However, it does mention that the injection is used for the management of moderately severe, acute pain.
- The recommended dose of ketorolac tromethamine injection for patients ≥65 years of age, renally impaired patients, and patients less than 50 kg is 15 mg every 6 hours, with a maximum daily dose of 60 mg 2.
- Tordol 15mg injection is likely referring to ketorolac tromethamine injection, but the label does not specifically address its use for migraine.
From the Research
Migraine Treatment Options
- The treatment of acute migraine headache often involves the use of nonprescription nonsteroidal anti-inflammatory drugs and combination analgesics containing acetaminophen, aspirin, and caffeine 3.
- Triptans are first-line therapies for moderate to severe migraine, or mild to moderate migraine that has not responded to adequate doses of simple analgesics 3, 4.
- Other treatment options for acute migraine include intravenous antiemetics, intravenous dihydroergotamine, dexamethasone, and intranasal lidocaine 3.
- Medications containing opiates or barbiturates should be avoided for acute migraine 3.
Specific Medications
- Tordol 15mg injection is not specifically mentioned in the provided studies, but other medications such as triptans, ergot derivatives, and nonsteroidal anti-inflammatory drugs are commonly used for acute migraine treatment 4, 5.
- Acetaminophen, ibuprofen, intranasal sumatriptan, and intranasal zolmitriptan are effective in children and adolescents, although data in these age groups are limited 3.
- Non-CGRP antagonist/non-triptan options for migraine disease treatment include NSAIDs, ß-blockers, calcium channel blockers, antidepressants, and antiepileptics 6.
Treatment Guidelines
- The American Headache Society (AHS) amended the treatment guideline of acute migraine based on evidence-based medicine (EBM) in 2015, recommending triptans, acetaminophen, and non-steroid anti-inflammation drugs-NSAID as effective treatments 5.
- The Taiwan Headache Society published its treatment guideline for acute migraine attack in 2007, recommending migraine-specific triptans and migraine-nonspecific nonsteroidal antiinflammatory drugs (NSAIDs) as first-line medications 5.
- The use of acute treatment should be limited to a maximum of ten days a month to prevent medication-overuse headache 5.