Intranasal Ketorolac Trial

Inclusion Criteria: * A headache that fulfills at least three of the six following criteria: i) moderate to severe episode of impaired daily activities; ii) focal localization of headache (focal meaning unilateral, bifrontal, bitemporal, or biparietal); iii) pulsatile description; iv) nausea or vomiting or abdominal pain; v) photophobia or phonophobia or avoidance of light and noise; and vi) symptoms increasing with activity or resolving by rest * Pain 4/10 on the validated Faces Pain Scale * Headache duration between 1 and 72 hours Exclusion Criteria: * Any contraindication to receiving ketorolac (e.g. known allergy, known peptic ulcer disease, gastrointestinal bleeding, hepatic impairment (patients with known aspartate aminotransferase (AST) \> 60 units/L "OR" alanine aminotransferase (ALT) \> 40 units/L "OR" total bilirubin \> 1.2 mg/dl) * Renal impairment (patients with known estimated glomerular filtration rate of \< 90 mL/min/1.73m2) * Known bleeding disorders * Receipt of an NSAID (e.g. ibuprofen, naproxen, naproxen/sumatriptan) within previous six hours * Receipt of oral prochlorperazine or metoclopramide or diphenhydramine within 12 hours prior to presentation * Presence of intranasal obstruction (e.g. mucous or blood) that cannot be readily cleared using suction or nose blowing * Inability to speak English * Patients with a concurrent diagnosis of traumatic brain injury * Unable to complete self-report measures of pain or questionnaires (e.g. developmental delay,…