From the Guidelines
For outpatient treatment of migraine, Toradol (ketorolac) is generally preferred as first-line injectable therapy over steroid injections due to its rapid efficacy and fewer side effects. According to the American College of Physicians guideline 1, the choice of treatment should be based on individualized decision making, taking into consideration patient preferences and factors such as route of administration and cost.
- Key points to consider when choosing between Toradol and steroid injections include:
- Toradol is typically administered as a 30-60mg intramuscular injection and works rapidly (within 30-60 minutes) by blocking prostaglandin synthesis to reduce inflammation and pain.
- Steroid injections, such as dexamethasone or methylprednisolone, are more commonly used for preventing migraine recurrence or breaking a prolonged migraine cycle rather than as first-line treatment.
- Toradol has the advantage of fewer side effects with single-dose use, though it should be avoided in patients with kidney problems, bleeding disorders, or gastrointestinal ulcers.
- Steroids carry more potential side effects including mood changes, insomnia, and elevated blood sugar, especially with repeated use.
- The guideline also recommends considering treatment of mild episodic migraine headache with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen, and using CGRP antagonists-gepants or ergot alkaloid for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy 1.
- Ultimately, the decision between Toradol and steroid injections should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, as well as the potential benefits and risks of each treatment option.
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.
Acute Pain in Adult Patients Ketorolac tromethamine is indicated for the short-term (≤5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting
The FDA drug label does not answer the question.
From the Research
Treatment Options for Migraine
- Toradol (ketorolac) and steroid injections are two treatment options for outpatient treatment of migraine.
- According to 2, steroids have been shown to be effective in reducing headache recurrence after discharge from the emergency department.
- A study published in 3 compared the therapeutic effects of dexamethasone-metoclopramide with ketorolac in relieving headache in patients with acute migraine attacks, and found that both treatments were effective in reducing pain intensity.
Efficacy of Corticosteroids
- Corticosteroids have been widely prescribed for the management of migraine attacks, with 26 heterogeneous clinical studies and four meta-analyses conducted to assess their efficacy 4.
- The majority of these studies revealed the superior efficacy of corticosteroids as mono- or adjunctive-therapy for both recurrent and acute migraine attacks.
- Corticosteroids can be administered safely up to six times annually, and are useful in managing patients with refractory headaches, history of recurrent headaches, severe baseline disability, and status migrainosus 4.
Comparison of Toradol and Steroid Injections
- A study published in 3 found that ketorolac (Toradol) had a relatively shorter pain reduction time compared to dexamethasone-metoclopramide, but the final response was identical in both groups.
- Another study published in 2 found that steroids afforded some protection against headache recurrence after discharge from the emergency department, while ketorolac was effective in relieving migraine pain.
- However, there is limited direct comparison between Toradol and steroid injections for outpatient treatment of migraine, and more research is needed to determine the most effective treatment option.