[7] More placebo-controlled studies are needed to further assess the efficacy of steroids in the treatment of various headache disorders. Practically, patients should be informed that the onset of pain relief from steroids is probably slower than that of a local anesthetic,

and thus their analgesic effect may not occur within the first 20 minutes of injections. Due to potential local and systemic AEs, the cautious use of corticosteroids is warranted in all patients, and particularly in those with diabetes or glaucoma.[22] Corticosteroids should be avoided when performing PNBs in the trigeminal branches, due to potential local AEs, including cutaneous atrophy.[10] The said recommendations represent the current recommendations among the AHS-IPS members on this topic. It should be noted that there is a paucity of evidence from controlled studies for the use of PNBs Selleckchem MK1775 in the treatment of BMS-777607 in vivo primary and secondary headache disorders, with the exception of GON blockade for CH. Further research on this topic is strongly encouraged, and may result in revision of the said recommendations, aiming

at further improving the outcome and safety of this treatment modality for headache. “
“Objectives.— (1) To establish whether pre-treatment headache intensity in migraine or episodic tension-type headache (ETTH) predicts success or failure of treatment with aspirin; and (2) to reflect, accordingly, on the place of aspirin in the management of these disorders. Background.— Stepped care in migraine management

uses symptomatic treatments as first-line, reserving triptans for those in whom this proves ineffective. Stratified care chooses between symptomatic therapy and triptans as first-line on an individual basis according to perceived illness severity. We questioned the 2 assumptions underpinning stratified care in migraine that greater illness severity: (1) reflects greater need; and (2) is a risk factor for failure of symptomatic treatment but not of triptans. Methods.— With regard to the first assumption, we developed a rhetorical argument that need for treatment is underpinned by expectation of benefit, not by illness severity. To address the second, we reviewed individual patient data from Teicoplanin 6 clinical trials of aspirin 1000 mg in migraine (N = 2079; 1165 moderate headache, 914 severe) and one of aspirin 500 and 1000 mg in ETTH (N = 325; 180 moderate, 145 severe), relating outcome to pre-treatment headache intensity. Results.— In migraine, for headache relief at 2 hours, a small (4.7%) and non-significant risk difference (RD) in therapeutic gain favored moderate pain; for pain freedom at 2 hours, therapeutic gains were almost identical (RD: −0.2%). In ETTH, for headache relief at 2 hours, RDs for both aspirin 500 mg (−4.2%) and aspirin 1000 mg (−9.7%) favored severe pain, although neither significantly; for pain freedom at 2 hours, RDs (−14.2 and −3.6) again favored severe pain. Conclusion.