Scherl and Wilson found that 1 hour headache relief was similar when comparing meperidine 75 mg plus promethazine 25 mg IM with DHE 0.5 mg plus metoclopramide 10 mg IV (77.2% vs 86.2%, P = .37).14 Stiell et al compared meperidine 75 mg plus dimenhydrinate 50 mg IM with methotrimeprazine (not available in the USA) 37.5 mg IM and found similar pain reduction (VAS) (−46.6 vs −40.3, P = .27).15 Alemdar et al compared tramadol 100 mg IV with placebo/NS IV.3 The percent pain free at 1 hour was not greater with tramadol (29.4% vs 11.8%, P = .40). Pain reduction (VAS) at 1 hour was greater in the tramadol group

(70.6% vs 35.3%, P = .04). No side effects were observed at 1 hour. Engindeniz et al compared tramadol 100 mg IM with diclofenac sodium 75 mg IM, and headache relief Sirolimus supplier was the same in both groups (80%).16 Tek and Mellon compared nalbuphine 10 mg IM with hydroxyzine 50 mg IM, with hydroxyzine plus

nalbuphine IM, and with placebo/NS IM.2 For migraineurs without aura only, headache relief at 1 hour was greatest with nalbuphine alone compared with the other treatments (nalbuphine −2.16 vs nalbuphine/hydroxyzine −1.42 vs hydroxyzine −1.00 vs placebo −0.89, P < .01). Table 1 PD0325901 clinical trial summarizes results from the studies involving meperidine, tramadol, and nalbuphine. Non-steroidal anti-inflammatory drugs (NSAIDs) can inhibit the neuroinflammatory cascade, prostaglandin synthesis, and platelet aggregation associated with the release of vasoactive substances, all processes that are involved in the initiation and prolongation of migraine. The cyclooxygenase COX1/COX2 inhibitors such as 上海皓元医药股份有限公司 ketorolac and indomethacin can inhibit the release of prostaglandins that activate nociceptive neurons in the spinal trigeminal nucleus, a process that leads to central sensitization in migraine.18 Seim et al found

ketorolac 30 mg IV reduced headache less at 1 hour than prochlorperazine 10 mg IV (−40 vs −71, P = .04).19 Meredith et al found ketorolac 30 mg IV to be more effective than sumatriptan 20 mg nasal spray.20 Jakubowski et al21 compared ketorolac 15 mg IV bolused twice successively (30 mg total) with sumatriptan 6 mg subcutaneous (SQ) for the delayed treatment (4 hours) of migraine with cutaneous allodynia. No patient in the sumatriptan group was pain free after 2 hours, compared with 64% in the ketorolac group at 1 hour (P < .05). Patients in the sumatriptan group were then given ketorolac after the 2-hour assessment, and an hour later, 71% of these patients were pain free (P < .05). All patients who were pain free were also allodynia free (and vice versa). There were 9 patients who did not respond to ketorolac. All of these nonresponders had a history of opioid use, as compared with only one of the 19 patients who did respond to ketorolac (P < .05).