Efficacy of ketorolac in the treatment of acute migraine attack: a systematic review and meta-analysis

Mohd Noor N 1 , Yazid MB 1 , Mohd Noor N 2 , Baharuddin KA 3 , Abu Bakar MA 3

Affiliations 

  • 1 Department of Emergency Medicine, Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Malaysia
  • 2 Department of Family Medicine, Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Malaysia
  • 3 Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
Acad Emerg Med, 2022 Feb 09.
PMID: 35138658 DOI: 10.1111/acem.14457

Abstract

OBJECTIVES: This review was designated to evaluate the efficacy of parenteral ketorolac in treating acute migraine headache.

METHODS: We searched databases Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Google Scholar up to January 2021 and identified randomised controlled trials comparing ketorolac to any other medications in treating patients presenting with migraine headache.

RESULTS: Thirteen trials were included in our review, comprising of 944 participants. We derived seven comparisons; ketorolac versus phenothiazines, metoclopramide, sumatriptan, dexamethasone, sodium valproate, caffeine, and diclofenac. There were no significant differences in the reduction of pain intensity at 1-hour under the comparisons between ketorolac and phenothiazines (standard mean difference (SMD) 0.09, P 0.74), or metoclopramide (SMD 0.02, P 0.95). We also found no difference in the outcome recurrence of headache [ketorolac vs phenothiazines (risk ratio (RR) 0.98, P 0.97)], ability to return to work or usual activity [ketorolac vs metoclopramide (RR 0.64, P 0.13)], need for rescue medication [ketorolac vs phenothiazines (RR 1.72, P 0.27), ketorolac vs metoclopramide (RR 2.20, P 0.18)], and frequency of adverse effects [ketorolac vs metoclopramide (RR 1.07, P 0.82)]. Limited trials suggested that ketorolac offered better pain relief at 1-hour compared to sumatriptan and dexamethasone, had lesser frequency of adverse effects than phenothiazines, and was superior to sodium valproate in terms of reduction of pain intensity at 1-hour, need for rescue medication and sustained headache freedom within 24-hour.

CONCLUSIONS: Ketorolac may have similar efficacy to phenothiazines and metoclopramide in treating acute migraine headache. Ketorolac may also offer better pain control than sumatriptan, dexamethasone and sodium valproate. However, given the lack of evidence due to inadequate number of trials available, future studies are warranted.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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