Can Toradol (Ketorolac) IV Be Used for Migraine?
Yes, ketorolac IV is an effective and evidence-based treatment for acute migraine, particularly for severe attacks requiring parenteral therapy, and is specifically recommended as a first-line IV option by major headache guidelines. 1
Evidence Supporting Ketorolac for Migraine
The American Academy of Family Physicians recommends ketorolac as a primary parenteral NSAID with relatively rapid onset of action and approximately six hours of duration, making it ideal for severe migraine abortive therapy with minimal risk of rebound headache. 1
Ketorolac has Level B evidence (probably effective) for both intramuscular and intravenous routes in acute migraine treatment according to the American Headache Society's evidence assessment. 2
The standard IV dose is 30 mg for patients under 65 years of age, with reduced doses for patients ≥65 years or with renal impairment. 1
Optimal Use Strategy
Ketorolac works best when combined with IV metoclopramide (10 mg) as first-line combination therapy for severe migraine attacks requiring intravenous treatment, providing rapid pain relief while minimizing side effects and risk of rebound headache. 1
This combination (metoclopramide + ketorolac) is specifically recommended over monotherapy approaches for severe migraine in the emergency or urgent care setting. 1
Treatment should begin as early as possible during the attack to improve efficacy. 1
Comparative Efficacy Data
In head-to-head trials, ketorolac provided moderate relief in 67% of migraine patients (6 of 9), though DHE with metoclopramide showed slightly greater improvement in pain and disability scores. 3
When compared to chlorpromazine 25 mg IV, ketorolac 60 mg IM demonstrated equivalent efficacy, with pain scores decreasing from 4.07 to 0.73 over 2 hours, with no side effects observed. 4
Self-administration studies showed 64% of patients achieved good response with significant pain reduction, 23% had mild response, and only 13% required emergency room treatment despite ketorolac use. 5
Important Contraindications and Cautions
Ketorolac should be used with caution in patients with renal impairment (creatinine clearance <30 mL/min), history of GI bleeding, or heart disease. 1
Limit use to no more than twice weekly to prevent medication-overuse headache, which can result from frequent use of acute medications. 1
Ketorolac has minimal risk of rebound headache compared to opioids or ergotamines, making it a safer choice for repeated use within appropriate frequency limits. 1
Clinical Pitfall to Avoid
Do not use ketorolac as monotherapy when significant nausea or vomiting is present—always add an antiemetic like metoclopramide or prochlorperazine, which provide synergistic analgesia beyond just treating nausea. 1
Avoid establishing patterns of daily or near-daily use, as this creates medication-overuse headache; if patients require treatment more than twice weekly, they need preventive therapy evaluation. 6, 1