Sumatriptan prophylaxis for postelectroconvulsive therapy headaches

Very little has been written about headaches following electroconvulsive therapy (ECT) but the incidence has been estimated at 26%. Patients with a history of migraine occasionally have similar headaches precipitated by ECT. In addition, some patients may have headaches that persist for months after a series of ECT treatments, while some patients who have a preexisting headache problem report improvement with ECT. Serotonergic mechanisms have been proposed both for the efficacy of ECT and its tendency to produce headaches in susceptible patients. There have been no studies on the prophylaxis or treatment of post-ECT headache. While various strategies have been suggested for these headaches, even case reports documenting the efficacy of these strategies are lacking. We, therefore, report a case of severe, refractory, post-ECT headaches which responded to prophylactic treatment with sumatriptan.