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The Course of Myalgia and Headache After Electroconvulsive Therapy

Dinwiddie, Stephen H. MD*; Huo, Dezheng PhD; Gottlieb, Ori MD

doi: 10.1097/YCT.0b013e3181b07c0a
Original Studies

Background: Headache and myalgia seem to be common, though generally mild, complications of electroconvulsive therapy. Relatively little is known regarding the usual severity and time course of these complaints.

Objective: This study examines the incidence, severity, and time course of myalgia and headache after electroconvulsive therapy.

Methods: Patients rated severity of myalgia and headache immediately before treatment and again after recovery and at 2, 6, 12, and 24 hours posttreatment on a 10-point visual analog scale. Data were analyzed using random-effects linear models.

Results: Severity of headache peaked 2 hours after treatment, returning to baseline by 24 hours and was relatively consistent within individuals between treatments. More severe posttreatment headache was reported by patients with a history of incapacitating headache and by those younger than 45 years. Headache was associated with increased duration of seizure. By contrast, myalgia was substantially more pronounced and lasted longer after the first treatment as compared with subsequent treatments. Severity of myalgia was not predicted by degree of fasciculations or motor activity, but was worse in patients younger than 45 years.

Conclusions: Posttreatment headache and myalgia are common but usually mild. Routine pretreatment using non-depolarizing agents is probably unnecessary in most cases but may have a role during the first treatment in a series. By contrast, preventive treatment may be warranted in those with history of severe headache and those who previously have had significant post-ECT headache.

From the *Department of Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, †Department of Health Studies, University of Chicago, and ‡Department of Anesthesia and Critical Care, University of Chicago Pritzker School of Medicine, Chicago, IL.

Received for publication February 5, 2009; accepted April 27, 2009.

Reprints: Stephen H. Dinwiddie, MD, Department of Psychiatry and Behavioral Neuroscience, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, Chicago, IL 60637-1470 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.