Treating the Pain After the Cure: Therapeutic Approaches for Post-ECT Headache-A Systematic Review

Headache is among the most frequently reported side effects of electroconvulsive therapy (ECT), yet it remains understudied and inconsistently managed. This systematic review aimed to synthesize and evaluate the effectiveness of pharmacological and nonpharmacological interventions for post-ECT headache. We conducted a comprehensive search of PubMed and Scopus databases up to July 2025 to identify all reports involving therapeutic interventions specifically targeting post-ECT headache. Seventeen articles were included, comprising case reports, case series, observational studies, and one randomized controlled trial. Treatments evaluated included sumatriptan, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, propranolol, topiramate, valproic acid, mirtazapine, dihydroergotamine, topical salicylates, cryotherapy, and percutaneous electrical nerve stimulation. Sumatriptan, supported only by observational studies, showed the most consistent benefit for acute headache relief, particularly in patients presenting with migraine-like symptoms. Prophylactic agents such as topiramate, valproic acid, and propranolol were effective in individual cases, especially for recurrent or severe headache phenotypes. NSAIDs demonstrated limited efficacy for post-ECT headache, although they may provide some benefit for myalgia. In contrast, paracetamol has been supported by evidence from a large randomized controlled trial, which showed a significant reduction in post-ECT headache. Nondrug interventions like cryotherapy showed promise in small cohorts with minimal side effects. Despite growing clinical interest, the quality of available evidence is low and highly heterogeneous. No standardized treatment recommendations currently exist. However, clinical phenotyping and a stepwise therapeutic approach may improve symptom control. This review provides a comprehensive summary of current options and offers guidance for individualized management of post-ECT headache.