Pain reduction was greater with MMZ than placebo for migraine both with and without aura. LC, in turn, outperformed MMZ in terms of the percentage pain free at 90 minutes, although the response rates for both were fairly impressive

(LC 86.7% vs MMZ 73%). Diclofenac sodium was as effective Apoptosis inhibitor as tramadol in reducing migraine pain, but ibuprofen PO was not more effective than placebo. The NSAIDs are nonsedating and can be combined with most other medications. While side effects can occur even after a single dose, these side effects generally are fewer and milder than those associated with narcotics, opiates/opioids, and dopamine antagonists. Contraindications to NSAID use include a history of GI bleeding, other bleeding risks, and renal impairment. Due to a recent report demonstrating a significantly increased risk of miscarriage, pregnancy now may represent a contraindication to NSAID use, and NSAIDs should not be administered to nursing mothers. There was a significant difference in the percentage of patients with sustained headache relief in 2 of the 6 studies that compared dexamethasone IV (6-24 mg single dose in ED) or oral prednisone Dinaciclib solubility dmso (40 mg times 2 days) with placebo. In all 4 remaining studies, the number of patients with sustained pain relief was greater in the steroid groups, although not sufficient to be significant. Using a paired t-test on

the percentage headache relief from these 6 studies, there is an overall significant difference between these scores for patients receiving dexamethasone compared with those receiving placebo (dexamethasone 69% vs placebo 51%, t = 2.9, d.f. = 5, P = .03). Side effects of single-dose dexamethasone were relatively few and benign. Patients receiving dexamethasone were more likely to report dizziness and less likely to report nausea than patients receiving placebo. There were equally low frequencies of reported numbness/tingling, drowsiness, restlessness, and swelling in the both steroid

and placebo arms. Repeated long-term use of steroids may increase the risk for osteoporosis and aseptic osteonecrosis of the femoral head and knees.43 Steroids should be used with caution in patients with diabetes. When patients are treated in the outpatient setting for headache lasting more than 72 hours, selleck inhibitor they may receive a course of steroids (dexamethasone, prednisone) for 3-5 days or more until headache free for 24 hours.27 A single dose of dexamethasone IV (or 2 daily doses of prednisone used in 1 study) may not be sufficient to produce much of an effect on the rate of headache recurrence. Patients in the 2 studies designed to treat headache recurrence experienced a recurrence rate exceeding 60%. The study designed to prevent headache recurrence by inducing sleep with secobarbital demonstrated a 6% headache recurrence rate in the secobarbital group vs 50% in the placebo group.