In people presenting with migraine headache, ketorolac might have similar effectiveness when compared to phenothiazines and metoclopramide for migraine treatment. Ketorolac therapy might also provide improved pain control when compared to sumatriptan, sodium valproate, and dexamethasone, as elucidated from a systematic review and meta-analysis published in Academic Emergency Medicine.

Nurathirah Mohd Noor et al. undertook this study to determine efficacy of parenteral ketorolac to treat acute migraine headache. Databases like Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar Medline were searched to find out randomized controlled trials investigating ketorolac vs. other medications to treat people suffering from migraine. A total of 13 trials and 944 people were incorporated in the review.

Overall, 7 comparisons were derived: ketorolac versus phenothiazines, diclofenac, metoclopramide, sumatriptan, caffeine, dexamethasone, and sodium valproate. No profound differences were noted in decrease of pain intensity at one-hour under the comparisons between ketorolac and phenothiazines (standard mean difference (SMD) 0.09), or metoclopramide (SMD 0.02).

No difference was noted in the outcome recurrence of headache [ketorolac vs phenothiazines (risk ratio (RR) 0.98], frequency of side effects [ketorolac vs metoclopramide (RR 1.07)], ability to return to work or usual activity [ketorolac vs metoclopramide (RR 0.64)], and requirement for rescue medication [ketorolac vs phenothiazines (RR 1.72), ketorolac vs metoclopramide (RR 2.20)].

Limited trials indicated that ketorolac therapy led to improved pain alleviation at one-hour in comparison with dexamethasone and sumatriptan, exhibited reduced frequency of side effects when compared to phenothiazines, and was superior to sodium valproate regarding the decrease in pain intensity at one hour, requirement for rescue medication and sustained headache freedom within 24-hour.

But, given the paucity of evidence due to the inadequate number of studies available, future robust trials are needed.