2018 myresearch Science Internship Program: Health Horizons. Civic Education Office of Government and Community Relations

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1 2018 myresearch Science Internship Program: Health Horizons Civic Education Office of Government and Community Relations

2 Amnerys Camacho Science Internship Program: Health Horizons

3 Alternative Treatments to Ketorolac for Post-ECT Headaches Amnerys Camacho Nora Finnegan, RN, MSN, NP-C Kimberly Cromer, RN

4 Abstract Electroconvulsive therapy, know as ECT or electroshock therapy, has been an exceptionally effective treatment since the 1930s for mood disorders such as major depression, schizophrenia, and bipolar disorder. ECT is recommended for patients who have been unresponsive to: - Medications such as antidepressants or 2 or more classes of drugs - Talk therapy Few side effects - headaches

5 Background 31.2% of patients are prescribed ketorolac to treat their incidence of headaches at Lutheran Hospital, according to Margret Mahoney. Ketorolac is a short-term anti-inflammatory drug that is used as treatment for moderate to severe headaches. A side effect is that it carries a high risk of gastric bleeding if used consecutively for over 5 days.

6 Problem/Purpose The problem is that treating patients who are experiencing a high incidence and pain following ECT treatment have a high risk of health complications. The purpose of the research was to find alternative treatments for the incidence of post-ect headaches that are effective but do not have such a high risk for a patient s health.

7 Objective Our objective was to determine alternative treatments other than ketorolac for post-ect headaches.

8 Methodology To find out this information, we did a literature review of patients who received different medications than ketorolac for post-ect headaches, and compared the percentages of headaches and methods used from 2001 to the present.

9 Data This bar graph shows the percentages of patients who had pain or no pain when treated with intranasal sumatriptan (IMITREX). They were assessed with a pain scale from 30 minutes until 2 hours after being treated with IMITREX.

10 The graph shows the percentages of patients who experienced post- ECT headaches after being treated with the medications. Data (cont.) Acetaminophen had 36% Placebo had 71.4%

11 Results According to the first study, intranasal sumatriptan has been highly effective and tolerated in patients with post-ect headaches. At the 2-hour assessment, half of the patients reported no headaches and the other half noted a decrease in pain, which was described as tolerable pain. According to the second study, the results were significantly good; there was a significant reduction in both the incidence and severity of post-ect with preemptive analgesia with acetaminophen.

12 Conclusions There are many other medications that can help with the incidence of post-ect. We found out that the role of preemptive analgesia with acetaminophen, treated two hours prior to electroconvulsive therapy, was very effective in reducing percentages of incidences and severity of post-ect headaches.

13 Recommendations A further study comparing treatments to see which treatment would be the best for the incidence of post- ECT headaches and have lower health side effects, and using different methods and time frames.

14 References Battikhi, B. (2017, August 21). Preemptive analgesia with acetaminophen reduces headaches associated with electroconvulsive therapy. Retrieved from ttps:// Isuru, A., Rodrigo, A., Wijesinghe, C., Ediriweera, D., Premadasa, S., Wijesekara, C., & and Kuruppuarachchi, L. (2017). A randomized, doubleblind, placebo-controlled trial on the role of preemptive analgesia with acetaminophen [paracetamol] in reducing headache following electroconvulsive therapy. BMC Psychiatry 17, 275. Markowitz, J.S., Kellner, C.H., DeVane, C.L., Beale, M.D., Folk, J., Burns, C., & Liston, H.L. (2001). Intranasal sumatriptan in post-ect headache: Results of an open-label trial. The Journal of ECT 17(4),

15 Special Thanks Nora Finnegan, RN, MSN, NP-C Kimberly Cromer, RN Roman Dale, MD Minnie Bowers, MD Florian Bahr, MD Nedra Starling, MA, MPH, DrPH/ABD Office of Government and Community Relations Civic Education Department

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