Intranasal steroids are used when

An excellent summary! As you point out, in the “headache cocktail” the anti-dopaminergic agents seem to do the heavy lifting in relieving symptoms in all types of headaches. I do have some issue with the evidence that says that adding anti-histamines to the migraine cocktail does not have an affect on subsequent akathisia or other EPS side effects. I certainly believe that benadryl does not improve pain, but in my practice when I stopped giving benadryl with compazine, everyone seemed to get akathisia! I know, anecdotal, but I still give compazine + benadryl (plus decadron if classic migraine).

Intranasal steroids are used when

intranasal steroids are used when

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