***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 The antimigraine drugs ergotamine and sumatriptan may cause angina-like symptoms , possibly result ing from coronary artery constriction . We compared the coronary vasoconstrictor potential of a number of current and prospect i ve antimigraine drugs ( ergotamine , dihydroergotamine , methysergide and its metabolite methylergometrine , sumatriptan , naratriptan , zolmitriptan , rizatriptan , avitriptan ) . METHODS AND RESULTS Concentration-response curves to the antimigraine drugs were constructed in human isolated coronary artery segments to obtain the maximum contractile response ( Emax ) and the concentration eliciting 50 % of Emax ( EC50 ) . The EC50 values were related to maximum plasma concentrations ( Cmax ) reported in patients , obtaining Cmax/EC50 ratios as an index of coronary vasoconstriction occurring in the clinical setting . Furthermore , we studied the duration of contractile responses after washout of the acutely acting antimigraine drugs to assess their disappearance from the receptor biophase . Compared with sumatriptan , all drugs were more potent ( lower EC50 values ) in contracting the coronary artery but had similar efficacies ( Emax < 25 % of K+-induced contraction ) . The Cmax of avitriptan was 7- to 11-fold higher than its EC50 value , whereas those of the other drugs were < 40 % of their respective EC50 values . The contractile responses to ergotamine and dihydroergotamine persisted even after repeated washings , but those to the other drugs declined rapidly after washing . CONCLUSIONS All current and prospect i ve antimigraine drugs contract the human coronary artery in vitro , but in view of low efficacy , these drugs are unlikely to cause myocardial ischemia at therapeutic plasma concentrations in healthy subjects . In patients with coronary artery disease , however , these drugs must remain contraindicated . The sustained contraction by ergotamine and dihydroergotamine seems to be an important disadvantage compared with sumatriptan-like drugs OBJECTIVE To investigate the cost-effectiveness and cost-benefit of initiating sumatriptan therapy in patients with acute migraine who were previously taking nontriptan drugs . PATIENTS AND METHODS This is an economic analysis of a prospect i ve , pretest-posttest , observational 6-month outcomes study of 178 patients with a physician diagnosis of migraine who received their first prescription for sumatriptan between October 1994 and August 1996 and were members of a mixed-model managed care organization in western Pennsylvania . Migraine-related re source use data were obtained from the managed care organization 's medical and pharmacy cl aims data bases . The primary outcome measure for this economic analysis was the total disability time that patients experienced because of migraine . Patients reported time missed from work and usual nonwork activities because of migraine on self-administered question naires at baseline and at 3 and 6 months after initiation of sumatriptan . RESULTS Initiation of sumatriptan result ed in a decrease of 662 migraine-disability-days for work and 1236 migraine-disability-days for nonwork activities during the 6 months of the study ( decrease from 27.8 to 17.2 days per person ) , totaling 1898 migraine-disability-days averted with sumatriptan therapy .  Migraine-related medical costs were lower after sumatriptan was initiated ( $ 18,351 vs $ 26,192 ) , whereas migraine-related pharmacy costs were lower with prior nontriptan drug therapy ( $ 22,209 vs $ 74,861 ) . The overall net cost savings after sumatriptan was initiated in these patients was $ 222,332 ( $ 1249 per patient ) with a benefit-to-cost ratio of $ 5.67 gained for each health care dollar spent from a societal perspective . The incremental cost-effectiveness ratio was $ 25 for each additional migraine-disability-day averted by using sumatriptan vs nontriptan drug therapy . Sensitivity analysis showed that changes in medical costs had little effect on the ratios and that sumatriptan remained cost-beneficial across a wide range of patient wages . CONCLUSION This study showed that initiation of sumatriptan in patients previously receiving nontriptan therapy was cost-effective and had an economic benefit for patients , employers , and society . Sumatriptan also helped patients and physicians achieve goals recommended by the US Headache Consortium by reducing patients ' disability and thus improving their ability to function at work and nonwork activities STUDY OBJECTIVE We compare prochlorperazine 10 mg intravenously versus metoclopramide 20 mg intravenously for the emergency department ( ED ) treatment of acute migraine . METHODS This was a r and omized , double-blind , clinical trial comparing 2 parenteral dopamine antagonists . Both drugs were administered during 15 minutes with 25 mg intravenous diphenhydramine .  Pain scores on a numeric rating scale were assessed at baseline , every 30 minutes for 2 hours , and by telephone 24 hours after discharge . The primary endpoint was the between-group difference in change in numeric rating scale from baseline to 1 hour postbaseline . Secondary endpoints included mean differences in change in numeric rating scale at 2 and 24 hours , headache relief , adverse effects , and desire to receive the same treatment for future migraines . RESULTS Of 152 patients screened , 97 were eligible and 77 were r and omized . The mean change in numeric rating scale scores at 1 hour was 5.5 and 5.2 in subjects receiving prochlorperazine and metoclopramide , respectively ( difference=0.3 ; 95 % confidence interval [ CI ] -1.0 to 1.6 ) . Findings were similar at 2 hours and 24 hours . Forty-six percent ( 18/39 ) of prochlorperazine and 32 % ( 12/38 ) of metoclopramide subjects reported adverse events ( difference=15 % ; 95 % CI -6 % to 36 % ) . Seventy-seven percent ( 26/34 ) of prochlorperazine and 73 % ( 27/37 ) of metoclopramide subjects wanted to receive the same medication in future ED visits ( difference=4 % ; 95 % CI -16 % to 24 % ) . CONCLUSION Either prochlorperazine 10 mg intravenously or metoclopramide 20 mg intravenously , combined with diphenhydramine 25 mg intravenously , is an efficacious treatment for ED patients with acute migraine . Three quarters of subjects in both arms would want the same medication for their next migraine The aim of this prospect i ve , r and omised , double – blind study was to evaluate the efficacy of intramuscular ( IM ) tramadol 100 mg in emergency department treatment of acute migraine attack and to compare it with that of IM diclofenac sodium 75 mg . Forty patients who were admitted to our emergency department with acute migraine attack according to the International Headache Society criteria were included in the study . Patients were r and omised to receive either tramadol 100 mg  ( n=20 ) or  diclofenac sodium 75 mg ( n=20 ) intramuscularly . Patients rated their pain on a four – point verbal scale ( 0=none , 1=mild , 2=moderate , 3=severe ) at the beginning of the trial and at 30 , 60 , 90 and 120 min . At each time interval , severity of associated symptoms were also question ed and recorded . Global evaluation of the drugs by patients and doctors were also recorded . Patients were also asked if they would prefer the same injection in future visits . Any adverse events , whether related to the drug or not , were also recorded . Patients were followed up by telephone 48 h later to check for any headache recurrence . Two – hour pain response rate , which was the primary endpoint , was 80 % for both tramadol and diclofenac groups . There were no statistically significant differences among groups in terms of 48–h pain response , rescue treatment , associated symptoms ’ response , headache recurrence and adverse event rates . Fifteen ( 75 % ) patients in the tramadol group and 16 ( 80 % ) patients in the diclofenac group stated that they may prefer the same agent for future admissions . In selected patients , tramadol 100 mg IM may be an effective and reliable alternative treatment choice in acute migraine attacks OBJECTIVE To assess the efficacy and tolerability of subcutaneous dihydroergotamine mesylate ( DHE-45 ) vs subcutaneous sumatriptan succinate ( Imitrex ) for the treatment of acute migraine with or without aura . DESIGN Double-blind , r and omized trial with parallel treatment arms . SETTING Clinics and private neurology practice s. SUBJECTS Patients of either sex , with migraine with or without aura , between the ages of 18 and 65 years . INTERVENTIONS Patients with moderate or severe head pain were r and omized to receive either 1 mg of subcutaneous dihydroergotamine mesylate or 6 mg of subcutaneous sumatriptan succinate . Patients rated head pain , functional ability , nausea , and vomiting at baseline and at 0.5 , 1 , 2 , 4 , and 24 hours after the injection . Presence or absence of headache at 3 hours was calculated from collected data . If pain persisted after 2 hours , a second injection of the same study medication was allowed , and self-ratings were repeated 30 and 60 minutes later . Follow-up data were collected at 24 hours . MAIN OUTCOME MEASURES Relief of head pain and recurrence of successfully treated headache . RESULTS There were 295 evaluable patients . At 2 hours , 73.1 % of the patients treated with dihydroergotamine and 85.3 % of those treated with sumatriptan had relief ( P = .002 ) . There was no statistical difference in headache relief between the groups at 3 or 4 hours . Headache relief was achieved by 85.5 % of those treated with dihydroergotamine and by 83.3 % of those treated with sumatriptan by 4 hours . By 24 hours 89.7 % of dihydroergotamine-treated patients and 76.7 % of sumatriptan-treated patients had relief ( P = .004 ) . Headache recurred within 24 hours after treatment in 45 % of the sumatriptan-treated patients and in 17.7 % of the dihydroergotamine-treated patients ( P < or = .001 ) . CONCLUSIONS Both sumatriptan and dihydroergotamine were effective in aborting migraine headaches . Headache recurrence was two and a half time as likely with sumatriptan as with dihydroergotamine STUDY OBJECTIVE We test the hypothesis that intravenous magnesium sulfate is an effective adjunctive medication for treatment of acute migraine .  METHODS In this r and omized , double-blind , placebo-controlled trial , adults presenting to 2 urban emergency departments with headache meeting International Headache Society criteria for acute migraine received either 20 mg of intravenous metoclopramide plus 2 g of intravenous magnesium sulfate or 20 mg of intravenous metoclopramide plus a placebo of intravenous saline solution at 15-minute intervals for a maximum of 3 doses or until pain relief occurred . At 0 , 15 , 30 , and 45 minutes , patients recorded pain intensity using a st and ard visual analog scale ( VAS ) . The primary study end point was the between-group difference in pain improvement when initial and final VAS scores were compared . RESULTS Of 44 patients enrolled ( 21 r and omized to metoclopramide plus magnesium and 23 to metoclopramide plus placebo ) , 42 ( 95 % ) were women . Baseline features were comparable in both groups . Each group experienced a more than 50-mm improvement in VAS score during the study . However , this improvement was smaller in the magnesium group for the primary end point ( 16-mm difference favoring placebo [ 95 % confidence interval ( CI ) -2 to 34 mm ] ) , as was the proportion with normal functional status at their final rating ( 36 % absolute difference also favoring placebo [ 95 % CI 7 % to 65 % ] ) . Using a 50 % reduction in pain to dichotomize VAS scores , the number needed to harm with magnesium plus metoclopramide versus metoclopramide alone is 4 patients ( 95 % CI 2 to 36 ) . CONCLUSION Although this result was unexpected , our data suggest that the addition of magnesium to metoclopramide may attenuate the effectiveness of metoclopramide in relieving migraine . Countertherapeutic cerebral vasodilatation caused by magnesium is a plausible , although unproven , explanation for this finding . Because of the preponderance of women in our trial , these data may not be generalizable to men 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. 
    Output:
    
Interpretation We strongly recommend the use of prochlorperazine based on a high level of evidence , lysine acetylsalicylic acid , metoclopramide and sumatriptan , based on a moderate level of evidence , and ketorolac , based on a low level of evidence .
We weakly recommend the use of chlorpromazine based on a moderate level of evidence , and ergotamine , dihydroergotamine , lidocaine intranasal and meperidine  , based on a low level of evidence .
We found evidence to recommend strongly against the use of dexamethasone , based on a moderate level of evidence , and granisetron , haloperidol and trimethobenzamide based on a low level of evidence .
Based on moderate- quality evidence , we recommend weakly against the use of acetaminophen and magnesium sulfate .
Based on low- quality evidence , we recommend weakly against the use of diclofenac , droperidol , lidocaine intravenous , lysine clonixinate , morphine , propofol , sodium valproate and tramadol