Pretreatment With Ibuprofen to Prevent Electroconvulsive Therapy–Induced Headache
J Clin Psychiatry 2003;64(5):551-553
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Although electroconvulsive therapy
(ECT) has been widely recognized as an effective treatment for
severe depression and various other psychiatric illnesses,
adverse effects have been frequently reported, especially a high
incidence of headache. Analgesics, such as acetaminophen,
narcotics, or nonsteroidal anti-inflammatory drugs (NSAIDs), are
commonly used to treat ECT-induced headache. The objective of
this study was to determine whether pretreatment with ibuprofen
would prevent the onset or decrease the severity of headache that
occurs after ECT.
Method: All inpatients on the psychiatric units
who required ECT treatment were asked to participate in the
study. Thirty-four patients were randomly assigned to receive
either ibuprofen, 600 mg, or placebo orally 90 minutes prior to
the initial ECT session, with the alternate treatment given for
the second ECT treatment. Patients were asked to complete a
questionnaire prior to and after the first 2 ECT treatments
regarding the pattern, severity, and onset of headache. Severity
of the headache was measured on a visual analogue scale (VAS).
Results: Ten patients experienced headache in
neither treatment arm, while 7 patients experienced headache in
both treatment arms. Eleven patients experienced headache with
placebo but not with ibuprofen, while 2 patients experienced
headache with ibuprofen but not with placebo. Ibuprofen was
significantly more effective than placebo in preventing the onset
of headache post-ECT (p = .022). The mean ± SD VAS headache
scores were 1.49 ± 1.54 and 0.54 ± 0.91 in the placebo and
ibuprofen arms, respectively. Ibuprofen was significantly more
effective than placebo in reducing the severity of ECT-induced
headache (p = .007).
Conclusion: Ibuprofen premedication reduced the
frequency and severity of headache post-ECT and should be
considered for appropriate patients who suffer from ECT-induced