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Headache Associated with Electroconvulsive Therapy

Author(s): Selcuki D, Batum M, Aysin Kisabay, Komurculu N, Aydemir O3, Esen-Danaci A

The electroconvulsive therapy (ECT) is a treatment method used in major depression, mania,
schizophrenia, and mixed affective conditions. The side effects of this therapy include
arrhythmia, hypertension, headache, prolonged seizures, amnesia, muscle pain, and nausea.
The characteristics of post-ECT headache and the effect of pre-ECT headache on post-ECT
headache were investigated in our study.

After obtaining the approval of the ethics committee, we retrospectively reviewed 337
patients aged between 18 and 70 who had an ECT indication and were applied ECT due to
one of the diagnoses of major depression, psychosis, or bipolar affective disorder as per the
DSM V criteria. The localization, severity and duration of post-ECT headache, the conditions
accompanying it and the need for its treatment were evaluated in line with the International
Classification of Headache Disorders 2018 criteria. Headache was questioned immediately
after the ECT, and at the 2nd and 4th hours.

From the 337 patients, 96 female (28.5%) and 241 male (71.5%), 33 patients (9.8%) were
found to have pre-ECT headache and 49 patients (14.5%) post-ECT headache. While pre-ECT
headache was more common among women (p=0.004), no difference was found between
the genders in post-ECT headache (p=0.853). While there was also no difference between
the severities of pre-ECT and post-ECT headaches (p=0.66), 10 (30.3%) out of 33 patients with
pre-ECT headache also had post-ECT headache (p<0.001). The mean duration of post-ECT
headache was 1.87 ± 3.55 hours and the mean severity (VAS) score was 4.61 ± .56. Only 9
(18.3%) of the patients with post-ECT received treatment.

The post-ECT headache in our study was mostly bilateral, more of a throbbing nature, mild to
moderate in severity, tolerable, and not accompanied by conditions such as nausea, vomiting
or dizziness. There was an association between pre-ECT and post-ECT headaches. Contribution
was made to the characteristics of the headache in excess of the current criteria.

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