Conflict of Interest: No conflict.
Ketorolac in the Treatment of Acute Migraine: A Systematic Review
Article first published online: 8 JAN 2013
© 2013 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 53, Issue 2, pages 277–287, February 2013
How to Cite
Taggart, E., Doran, S., Kokotillo, A., Campbell, S., Villa-Roel, C. and Rowe, B. H. (2013), Ketorolac in the Treatment of Acute Migraine: A Systematic Review. Headache: The Journal of Head and Face Pain, 53: 277–287. doi: 10.1111/head.12009
Financial Support: This study was partially funded by the Department of Emergency Medicine at the University of Alberta. Ms. Taggart was supported by Northern Alberta Clinical Trials and Research Center and Canadian Institutes of Health Research (CIHR) summer studentships. Dr. Villa-Roel is supported by the CIHR in partnership with the Knowledge Translation branch. Dr. Rowe is supported by the CIHR as Tier I Canada Research Chair in Evidence-based Emergency Medicine from the Government of Canada (Ottawa, ON).
- Issue published online: 22 FEB 2013
- Article first published online: 8 JAN 2013
- Manuscript Accepted: 8 OCT 2012
- University of Alberta
- migraine headache;
- nonsteroidal anti-inflammatory agents;
- emergency department;
- pain relief
This systematic review examined the effectiveness of parenteral ketorolac (KET) in acute migraine. Acute migraine headaches are common emergency department presentations, and despite evidence for various treatments, there is conflicting evidence regarding the use of KET. Searches of MEDLINE, EMBASE, Cochrane, CINAHL, and gray literature sources were conducted. Included studies were randomized controlled trials in which KET alone or in combination with abortive therapy was compared with placebo or other standard therapy in adult patients with acute migraine. Two reviewers assessed relevance, inclusion, and study quality independently, and agreement was measured using kappa (k). Weighted mean differences (WMD) and relative risks are reported with 95% confidence intervals (CIs). Overall, the computerized search identified 418 citations and 1414 gray literature citations. From a list of 34 potentially relevant studies (k = 0.915), 8 trials were included, involving over 321 (141 KET) patients. The median quality scores were 3 (interquartile range: 2-4), and two used concealed allocation. There were no baseline differences in 10-point pain scores (WMD = 0.07; 95% CI: −0.39, 0.54). KET and meperidine resulted in similar pain scores at 60 minutes (WMD = 0.31; −0.68, 1.29); however, KET was more effective than intranasal sumatriptan (WMD = −4.07; 95% CI: −6.02 to −2.12). While there was no difference in pain relief at 60 minutes between KET and phenothiazine agents (WMD = 0.82; 95% CI: −1.33 to 2.98), heterogeneity was high (I2 = 70%). Side effect profiles were similar between KET and comparison groups. Overall, KET is an effective alternative agent for the relief of acute migraine headache in the emergency department. KET results in similar pain relief, and is less potentially addictive than meperidine and more effective than sumatriptan; however, it may not be as effective as metoclopramide/phenothiazine agents.