HEADACHE AND ELECTROCONVULSIVE-THERAPY

While headache is a documented side effect of electroconvulsive therap y (ECT), there is little information on this phenomenon. Studies of th e mechanisms of ECT as a treatment for depression indicate that altera tions in serotonergic neurotransmission appear to be related to its ef ficacy. While ECT and many of the antidepressant drugs have similar ef fects on serotonergic transmission, they are notably different in the changes they induce in type 2 receptors for 5-hydroxytryptamine (5-HT) . ECT upregulates 5-HT2, and antidepressants down regulate the recepto r's expression. 5-HT2 receptor sensitization has been associated previ ously with headache genesis, which may explain why ECT induces headach e, and amitriptyline relieves headache. In our study we surveyed 98 pa tients retrospectively about their experiences with headache prior to and following ECT. Of the 54 patients who submitted properly completed questionnaires, five reported new onset of headaches following ECT, f our reported exacerbation of a previous headache problem, and two repo rted their headaches improved. The patients experienced changes in the character or location of pain, with a tendency to progress from tensi on-type to migrainous headache. In all but two cases these development s persisted at least eight months after ECT. We discuss the possible r easons and significance of our findings.