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[16] [17] In pregnancy, paracetamol and metoclopramide are deemed safe as are NSAIDs until the third trimester. [12] Intravenous metoclopramide is also effective by itself. [18] [19] Several NSAIDs, including diclofenac and ibuprofen, have evidence to support their use. [20] [21] Ibuprofen provides effective pain relief in about 50%. [22]
A meta-analysis of 53 clinical trials has shown that all triptans are effective for treating migraine at marketed doses and that naratriptan, although less effective than sumatriptan and rizatriptan was more effective than placebo in reducing migraine symptoms at two hours [3] and efficacy was demonstrated in almost two thirds of subjects after four hours of treatment.
Metoclopramide is a medication used to treat nausea, vomiting, gastroparesis, and gastroesophageal reflux disease. [5] It is also used to treat migraine headaches. [6]Common side effects include feeling tired, diarrhea, akathisia, and tardive dyskinesia.
Use is not recommended in the third trimester of pregnancy. [8] Naproxen is a nonselective COX inhibitor. [8] As an NSAID, naproxen appears to exert its anti-inflammatory action by reducing the production of inflammatory mediators called prostaglandins. [10] It is metabolized by the liver to inactive metabolites. [8]
In third trimester of pregnancy [18] Persons who have undergone gastric bypass surgery [ 37 ] [ 38 ] Persons who have a history of allergic or allergic-like NSAID hypersensitivity reactions , e.g. aspirin-exacerbated respiratory disease [ 39 ]
Methylergometrine is sometimes used for both prevention [6] and acute treatment [7] of migraine. It is an active metabolite of methysergide. [8] In the treatment of cluster headaches, methylergometrine has been initiated at a dose of 0.2 mg/day, rapidly increased to 0.2 mg three times per day, and increased to a maximum of 0.4 mg three times per day.
The triptan drug class includes 1st generation sumatriptan (which has poor bioavailability), and second generation zolmitriptan. [2] Due to their safety, efficacy and selectivity, triptans are considered first line agents for abortion of migraines. [2]
Eletriptan, sold under the brand name Relpax and used in the form of eletriptan hydrobromide, is a second-generation triptan medication intended for treatment of migraine headaches. [3] [4] It is used as an abortive medication, blocking a migraine attack which is already in progress.