The Prevalence and Factors Associated with Headache in Patients After Electroconvulsive Therapy
Article Sidebar
Main Article Content
Abstract
Objective: While electroconvulsive therapy (ECT) is generally well-tolerated, headaches have been widely reported for ages. The factors influencing their occurrence also vary in results and are poorly understood. Therefore, the study aimed to determine the prevalence of post-ECT headaches and identify associated risk factors.
Methods: This retrospective study reviewed the medical records of 101 psychiatric inpatients receiving ECT at Ramathibodi Hospital from September 2017 to February 2023). Post-ECT headache in our study was defined as a headache within 24 hours after treatment, either self-reported or identified by a nurse, and received medication afterwards.
Results: Post-ECT headaches were reported by 53 patients (52.5%). Significant factors associated with headaches included younger age (mean 40 vs. 49 years; p = 0.01) and right unilateral electrode placement (68% vs. 32%; p = 0.001). The headache group had a lower mean maximum charge across sessions (333 ± 138.7 mC vs. 413 ± 154.5 mC; p = 0.01). Adjusted analysis showed a slight but significant decrease in headache risk with increasing charge (adjusted OR = 0.99, p = 0.01).
Conclusions: Post-ECT headaches affected 52.5% of patients in this study, with younger age and right unilateral placement as key associations with post-ECT headaches. The high prevalence highlights the need for future research on preventing high-risk populations.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles submitted for consideration must not have been previously published or accepted for publication in any other journal, and must not be under review by any other journal.
References
Fink M. Convulsive therapy: a review of the first 55 years. J Affect Disord 2001;63(1–3):1–15.
Munk-Olsen T, Laursen TM, Videbech P, Mortensen PB, Rosenberg R. All-cause mortality among recipients of electroconvulsive therapy: register-based cohort study. Br J Psychiatry 2007;190(1):435–9.
UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003;361(9360):799–808.
Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg 2002;94(5):1351–64.
Weiner SJ, Ward TN, Ravaris CL. Headache and electroconvulsive therapy. Headache 1994;34(3):155–9.
Charernboon T, Tangwongchai S, Karnjanathanalers N. Prevalence of adverse events and related factors from electroconvulsive therapy among psychiatric inpatients at King Chulalongkorn Memorial Hospital. Chula Med J 2008;52(1):43–58.
Andrade C, Arumugham S, Thirthalli J. Adverse effects of electroconvulsive therapy. Psychiatr Clin North Am 2016;39(3):513–30.
Dinwiddie SH, Huo D, Gottlieb O. The course of myalgia and headache after electroconvulsive therapy. J ECT 2010;26(2):116–20.
Kramer BA, Kadar AG, Clark K. Use of the neuro-wrap system for severe post-electroconvulsive therapy headaches. J ECT 2008;24(2):152–5.
Sackeim HA, Prudic J, Devanand DP, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry 2000;57(5):425–34.
Sackeim H, Decina P, Prohovnik I, Malitz S. Seizure threshold in electroconvulsive therapy: effects of sex, age, electrode placement, and number of treatments. Arch Gen Psychiatry 1987;44(4):355–60.
Haghighi M, Sedighinejad A, Naderi Nabi B, Emiralavi C, Biazar G, Mirmozaffari K, et al. The incidence and predictors of headache and myalgia in patients after electroconvulsive therapy (ECT). Anesth Pain Med 2016;6(3): e33724.
Rasmussen KG. A randomized controlled trial of ketorolac for prevention of headache related to electroconvulsive therapy. Pain Stud Treat 2013;2:33,862.
American Psychiatric Association Committee on Electroconvulsive Therapy. The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging. 2nd ed. APA Press; 2001. p. 62–5.
Isuru A, Rodrigo A, Wijesinghe C, et al. A randomized, double-blind, placebo-controlled trial on the role of preemptive analgesia with acetaminophen (paracetamol) in reducing headache following electroconvulsive therapy (ECT). BMC Psychiatry 2017;17(1):1–7.
Leung M, Hollander Y, Brown GR. Pretreatment with ibuprofen to prevent electroconvulsive therapy-induced headache. J Clin Psychiatry 2003;64(5):551–3.
Kertesz D, Trabekin O, Vanetik M. Headache treatment after electroconvulsive treatment: a single-blinded trial comparator between eletriptan and paracetamol. J ECT 2015;31(2):105–9.
Markowitz J, Kellner C, DeVane C, et al. Intranasal sumatriptan in post-ECT headache: results of an open-label trial. J ECT. 2001;17(3):280–3.
White PF, Purdue L, Downing M, et al. Intranasal sumatriptan for prevention of post-ECT headaches. Headache 2006;46(4):692–7.
Poulet E, Auriacombe M, Tignol J. Seizure threshold and electroconvulsive therapy: importance for good clinical practice of ECT. Encephale 2003;29(2):99–107.
Mulder H, Grootens KP. The incidence of post-electroconvulsive therapy headache: a systematic review. J Affect Disord 2020;272(1):109–15.
Zottmann C, editor. EKT und unerwünschte Ereignisse – eine retrospektive Analyse an der Universitätsmedizin Göttingen. 2017.
Karaaslan E, Akbas S, Ozkan AS, Zayman EP. Effects of preemptive intravenous paracetamol and ibuprofen on headache and myalgia in patients after electroconvulsive therapy: A placebo-controlled, double-blind, randomized clinical trial. Medicine (Baltimore) 2019;98(51):e18473.
