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

Abstract

This review was designated to evaluate the efficacy of parenteral ketorolac in treating acute migraine headache. We searched databases Cochrane Central Register of Controlled Trials (CENTRAL), Medline, and Google Scholar up to January 2021 and identified randomized controlled trials comparing ketorolac to any other medications in treating patients presenting with migraine headache. Thirteen trials were included in our review, comprising 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 1h 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 1h 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 1h, need for rescue medication, and sustained headache freedom within 24h. 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.