***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE Glyceryl trinitrate ( GTN ) induces delayed migraine attacks in migraine patients . The purpose of this study was to investigate whether pre-treatment with prednisolon could decrease this effect of GTN . METHODS In this double-blind , r and omized and placebo-controlled , crossover study 15 migraineurs with migraine without aura were pre-treated with 150 mg of prednisolone or placebo followed by a 20-min infusion of GTN ( 0.5 ug/kg/min ) . One hour after the GTN-infusion , the participants were sent home , but continued to rate headache and possible associated symptoms by filling out a headache diary every hour for 12 h. There were two equal primary efficacy end-points : frequency of delayed migraine and intensity of delayed headache . RESULTS Nine patients experienced a  GTN headache fulfilling the diagnostic criteria for migraine without aura on the placebo day compared with four patients on the prednisolone day ( P = 0.14 ) . Prednisolone pre-treatment did not alter the summed or peak immediate headache responses to GTN significantly ( P = 0.08 , P = 0.07 ) , whereas the peak headache scores during the following 12 h were significantly lower after prednisolone pre-treatment ( median peak score = 1 , range 0 - 8 ) compared with placebo ( median = 4 , range 0 - 8 ) ( P < 0.01 ) . There was no difference between the two treatment days in the effect of GTN on blood flow velocity of the middle cerebral artery ( a decrease ) or on the dilation of the superficial temporal artery or the radial artery . CONCLUSION Pre-treatment with prednisolone did not reduce the immediate GTN-induced headache , did not inhibit the frequency of delayed headache but significantly decreased the intensity of delayed GTN-induced headache . These findings suggest that GTN causes induction of inflammatory mediators , and that this is the mechanism of delayed GTN-induced migraine . They also support a role of inflammatory mediators in spontaneous migraine attacks OBJECTIVE To determine whether the addition of intravenous dexamethasone to st and ard emergency department ( ED ) migraine therapy would decrease the incidence of severe recurrent headache 24 to 48 hours after initial treatment . METHODS Patients aged 19 to 65 years whose headache was severe enough to require parenteral therapy and who met International Headache Society migraine criteria were eligible for this r and omized , double-blind trial . The study was conducted in the ED of 2 community hospitals , 1 of which was a tertiary referral centre . Exclusion criteria included pregnancy , focal findings , fever , meningismus , allergy to the study drug , active peptic ulcer disease and diabetes mellitus . Demographic and clinical data , including headache severity , were recorded . After abortive therapy ( antiemetics , intravenous nonsteroidal agents , dihydroergotamine or opioids ) , blinded nurses administered dexamethasone ( 24 mg intravenously ) or placebo . Patients recorded headache severity on a Visual Analogue Scale ( VAS ) at time T = 0 , T = 30 minutes and T = 60 minutes and at discharge . They were contacted 48 to 72 hours later and asked whether they had suffered a recurrence of their headache , categorized as class A ( severe , provoking another physician visit ) , class B ( severe , interfering with daily activity but not provoking a physician visit ) , class C ( mild , requiring self-medication but not limiting activity ) or class D ( mild , requiring no treatment ) . RESULTS Two of 100 patients were lost to follow-up , leaving 98 in the study sample . Placebo recipients were more likely to be female ; other baseline characteristics were similar between groups . Median VAS pain score was 83 mm on ED arrival , 35 mm after initial treatment and 12 mm on discharge . At follow-up , 65 of 98 patients had suffered headache recurrence . In the placebo versus dexamethasone groups , respectively , the results were 11 versus 0 in class A , 11 versus 9 in class B , 7 versus 11 in class C and 4 versus 12 in class D. Regarding the primary outcome , 9 of 49 dexamethasone patients ( 18 % ) and 22 of 49 placebo patients ( 45 % ) had severe ( classes A and B ) recurrent headache ( odds ratio 0.28 ; 95 % CI , 0.11 to 0.69 ; p = 0 .005 ) . CONCLUSIONS Migraine recurrence is common after " successful " ED treatment . Inflammation may be a critical factor in migraine genesis . Intravenous dexamethasone decreases the incidence of severe recurrent headache after ED treatment and should be offered to patients thought to be at risk of recurrent headache Chronic migraine ( CM ) patients frequently overuse symptomatic medications ( SM ) . These medications may create a cycle of rebound , worsening of headache and withdrawal symptoms that perpetuate the headache itself . In addition , the overuse of such substances is believed to counteract the efficacy of preventive treatments . We conducted a prospect i ve r and omized open-label trial comparing approaches to out-patient management in 150 CM patients ( 125 women , 25 men ; ages 18 - 80 years , mean 40.3 ± 13.8 ) with overuse of SM . In each group , 50 patients received education and orientation and were then abruptly withdrawn from all SM . Immediately following withdrawal , the first group took prednisone ( 60 mg/day 2 days , 40 mg/day 2 days and 20 mg/day 2 days ) for 6 days , the second group did not have any regular medications to take and the third group took naratriptan ( 2.5 mg twice a day ) during this initial period . All patients had similar profiles of headache characteristics and consumption ( quality and quantity ) of SM before initiation of the treatment , but most were not severe headache sufferers , heavy SM overusers or were overusing opioids . After 5 weeks the headache frequency and intensity , the prevalence and frequency of withdrawal symptoms and consumption of rescue medications during the first 6 days were compared between groups . In addition , adherence to treatment ( who returned or not and for which reasons , between groups ) and headache frequency , week by week , among the groups of patients were also compared . Forty-four ( 88 % ) patients from the prednisone group , 41 ( 82 % ) from the ‘ nothing ’ group and 35 ( 70 % ) from the naratriptan group adhered to the treatment and returned . The were no differences between groups with regard to treatment adherence ( P = 0.072 ) , headache frequency as well as intensity ( P = 0.311 ) and decreasing of days with headache after 5 weeks and weekly ( P = 0.275 ) . However , the incidence of withdrawal symptoms and consumption of rescue drugs was higher among the patients who did not take regular medications during the first 6 days ( P = 0.0001 and P = 0.006 ) . We concluded that CM patients with moderate overuse of SM other than opioids may be detoxified on an out-patient basis regardless of the strategy adopted with regard to the use of regular drugs during the initial days of withdrawal , but prednisone and naratriptan may be useful for reducing withdrawal symptoms and rescue medication consumption . Further controlled studies are necessary to confirm these observations Background : Intravenous Valproate ( IVVP ) has been used in the treatment of migraine in some studies ; however , it is far better known in the management of status epilepticus . Methods : Consecutive patients with migraine in our Headache Clinic were enrolled in this prospect i ve , r and omized clinical trial in 2011 . The patients were r and omized into two therapeutic groups , one receiving 900 mg IVVP ( Orifil ) and the other 16 mg IV Dexamethasone ( IVDEX ) diluted in 150 CC normal saline and infused for 10 minutes . Worst severity of pain before treatment and least severity at 3 hours after the infusion using a 0 - 10 point numeric rating scale were recorded . An interview with the patient was performed 72 hours after treatment to detect a possible relapse of headache . Results : Thirty-one migraine status patients , comprising 28 women and 3 men at a mean±SD age of 33.355±12.373 SD , were investigated . Differences in the therapeutic effects of IVVP ( Orifil ) and IVDEX  on pain score were not significant between the two groups ( t=0.933 , df=29 ; P=0.358 ) . Relapse of headache occurred in 68.42 % of the IVVP ( Orifil ) group and 66.67 % of the IVDEX group . Distribution of relapse was not significantly different between the two therapeutic groups of patients ( P=0.870 ) . Conclusion : IVVP ( Orifil ) was similar in efficacy to IVDEX as abortive therapy in patients with migraine status . IVVP ( Orifil ) appears to offer a safe and well-tolerated abortive treatment . Trial Registration Number : I RCT Purpose To investigate the efficacy of prednisone for treatment of withdrawal headache in patients with medication overuse headache ( MOH ) . Patients and methods In this prospect i ve double-blind , placebo-controlled , parallel design ed multicentre trial , 96 consecutive patients with MOH were r and omized to withdrawal treatment with either 100 mg prednisone or placebo over 5 days . Patients were enrolled if they met the International Headache Society criteria for MOH and were diagnosed with migraine or episodic tension-type headache as primary headache . Exclusion criteria comprised significant neurological or psychiatric disorders . Withdrawal symptoms , including headache severity and intake of rescue medication , were documented for 14 days after r and omization . Results Patients treated with prednisone did not experience fewer hours of moderate or severe headache than patients receiving placebo . However , patients requested less rescue medication within the first 5 days . Conclusions During withdrawal in MOH , prednisone reduces rescue medication without decreasing the severity and duration of withdrawal headache Background There are many drugs recommended for pain relief in patients with migraine headache . Methods In a prospect i ve double blind r and omized clinical trial , 90 patients ( age ≥ 18 ) presenting to Emergency medicine Department with Migraine headache were enrolled in two equal groups . We used intravenous propofol ( 10 mg every 5–10 minutes to a maximum of 80 mg , slowly ) and intravenous dexamethasone ( 0.15 mg/kg to a maximum of 16 mg , slowly ) , in group I and II , respectively . Pain explained by patients , based on VAS ( Visual Analogue Scale ) was recorded at the time of entrance to ED , and after injection . Data were analyzed by paired sample s t test , using SPSS 16 . P < 0.05 was considered to be statistically significant . Results The mean of reported pain ( VAS ) was 8 ± 1.52 in propofol group and 8.11 ± 1.31 in dexamethasone group at presenting time ( P > 0.05 ) . The VAS in propofol group was obviously decreased to 3.08 ± 1.7 , 1.87 ± 1.28 and 1.44 ± 1.63 after 10 , 20 and 30 minutes of drug injection , respectively . The VAS in dexamethasone group was 5.13 ± 1.47 , 3.73 ± 1.81 and 3.06 ± 2 after 10 , 20 and 30 minutes of drug injection , respectively . The mean of reported VAS in propofol group was less than dexamethasone group at the above mentioned times ( P < 0.05 ) . The reduction of headache in propofol group , also , was very faster than dexamethasone group ( P < 0.05 ) . There were no adverse side effects due to administration of both drugs . Conclusions Intravenous propofol is an efficacious and safe treatment for patients presenting with Migraine headache to the emergency department . Trial registration Clinical Trials I RCT OBJECTIVE To evaluate whether the addition of intravenous ( i.v . ) dexamethasone to st and ard emergency department ( ED ) benign headache therapy would reduce the incidence of headache recurrence at 48 - 72 hours . METHODS This r and omized , double-blind , placebo-controlled clinical trial of adult patients presenting with the chief complaint of headache was conducted in the ED of 2 academic , urban Level 1 hospitals . Headache evaluation and therapy were determined by the treating physician , and , before discharge , patients were administered either 10 mg of IV dexamethasone or placebo . The treatment groups had similar baseline characteristics , abortive therapy , IV fluids and degree of pain relief achieved before discharge . Patients were contacted 48 - 72 hours following discharge and asked whether their headache was " better , " " worse " or " remained unchanged " when compared with their symptoms at discharge . Those whose headaches were " worse " or " unchanged , " and those who reported a return of headache after being pain free at discharge were considered to be treatment failures and classified as having had a recurrence . The patient 's headache at follow-up was further categorized as severe ( i.e. , provoking another physician visit or interfering with daily activity ) or mild ( i.e. , requiring self-medication or no treatment ) . RESULTS Fifty-seven patients met the inclusion criteria and 2 were lost to follow-up , leaving 5 
    Output:
    
All meta-analyses revealed efficacy of adjuvant corticosteroids to various abortive medications — indicating generalizability .
Adverse effects were tolerable .
Higher disability , status migrainosus , incomplete pain relief , and previous history of headache recurrence predicted outcome favorability .
Conclusions Our literature review suggests that with corticosteroid treatment , recurrent headaches become milder than pretreated headaches and later respond to nonsteroidal therapy .
Single-dose intravenous dexamethasone is a reasonable option for managing resistant , severe , or prolonged migraine attacks