The Netherlands Pharmacovigilance Center Lareb, in 2022, reported headache as the commonest adverse effect of intranasal corticosteroids (143 events out of 1258 individual) (Vol.:(0123456789) Drugs - Real World Outcomes (2022) 9:321–331; https://doi.org/10.1007/s40801-022-00301-x).
Migraine is also commonly reported, according to another database study, performed using VigiBase data (Ann Allergy Asthma Immunol. 2008;101(1):67–73. https:// doi. org/ 10. 1016/ S1081- 1206(10) 60837-X.; Cephalalgia 2009; 29:360–364)
What is the fundamental mechanism(s) underlying the cephalalgogenic effect of corticosteroids?
Can the continued clinical use of corticosteroids in the ED as therapeutic agents to abort migraine attacks be justified?
Educating the patients is far less important than educating the therapists managing migraine attacks on the basis of canonical belief.
Use of corticosteroids in aborting protean and unpredictably self-limited (4-72 hours) migraine attacks is a purely empirical unjustified approach that must be stopped immediately.
Belief unsupported by robust logic /matrix is nothing but a tragic myth.
For too long migraine / primary headache theory and therapy has remained mired in myths.
Primacy of the migraine / primary headache patients, ignored by tertiary-care Institutional Headache care-research centres as well as International Associations / Advocacy Groups up to the near-middle of the 21st century, is long overdue.
Use / misuse / clinical trials of corticosteroids in managing migraine / primary headache should be immediately abolished.
Institutional headache researchers and specialists must not allow history, with 20:20 hindsight, to mock them.
History of science is always unforgiving.
ORCID ID: https://orcid.org/0000-0002-6770-5916.
Corticosteroids can induce headache by many mechanisms, one of them is the increased intracranial pressure.
Corticosteroids also can be used to abort status migrainous when given for short period.
Ali Al-shakerji
Thank you for your response.
From more than half-a-century, corticosteroids have been used to treat brain injury and tumours, because they are thought to reduce intracranial pressure. The significant increase in deaths with steroids, however, suggests that steroids should no longer be routinely used in people with traumatic head injury. The role of multiple confounding factors to deaths following corticosteroid use in critical TBI cannot be excluded, including magnesium supplements
Primary headaches/ Migraine due to increased ICP absolutely cannot rationalize lateralizing headache (unilateral, bilateral, side-shifting, side-fixed) or exclusive involvement of first division of the trigeminal nerve (V1) -- fundamnetal laws I and II of migraine pathophysiology.
Unilateral headache occurs in ~80% of primary headaches, including migraine. "Megrim" is half-sided headache, an absolute known since the time of Hippocrates. In the last 100 years, migraine leaders have done their best to dilute this unilateral almost pathognomonic feature. Scintillating scotoma is also unilateral, NEVER affecting the nasal visual retinal field, and revolutionizing the science of migraine. Gupta VK. Med Hypotheses. DOI: 10.1016/j.mehy.2005.11.010; Article CSD, BBB and MMP-9 elevations: Animal experiments versus cli...
Migraine / status migrainosus is a hopelessley jumbled entity due to a sophisticated hyper-split purely symptomatic classification (IHS, 2018) wherein almost everything can potentially treat any form of primary headache.
Corticosteroids, potent anti-inflammatory drugs like prednisone or dexamethasone, can induce headache or migraine through various mechanisms. They may lead to changes in blood pressure, potentially triggering headaches or exacerbating existing migraines. Additionally, these medications can cause fluid retention, resulting in swelling and increased pressure in blood vessels, which can contribute to headache development. Corticosteroids may also disrupt the body's natural hormone balance, potentially leading to hormonal headaches, especially in those predisposed to them. Moreover, they can impact blood sugar levels, potentially causing headaches in individuals sensitive to glucose fluctuations. While corticosteroids are not typically the first-line treatment for migraines, they may be considered in cases of severe, prolonged, or refractory migraines that have not responded to other treatments. However, due to potential risks and side effects, especially with prolonged or high-dose use, the decision to use corticosteroids for migraine treatment should be carefully weighed on a case-by-case basis under the close supervision of a qualified healthcare professional. It's essential to consult with a healthcare provider who is aware of your specific medical history and circumstances for personalized advice on your treatment plan.
Sharjeel Chaudhry
I am delighted that you, Sharjeel, unlike the other 15 million members of RG (checked as on today) with at least 15-20% suffering from migraine (i.e., 2.5 to 3.0 million educated scientists), not the lay population without any or with a minimal hazy idea of science, chose to respond with your belief of the role of corticosteroids in management of migraine/prolonged migraine/status migraine.
As long as there are scientists like you who still retain critical thinking and are NOT prepared to sit-on-the-fence or dodge discussion of important issues or keep on performing therapeutic clinical trials without basic science foundations or publish fishing-expeditions through statistics or maintain the cart-before-the-horse or celebrate barn-wide gaps in scientific logic by sweeping them under the carpet of myths-and- assumptions, there is still some hope for the occult migraine code to be broken down in to human understanding.
Let us start.
Is migraine / hemicrania / megrim a unilateral or non-lateralizing bilalteral headache / cranial algogenic phenomenon?
ORCID ID: https://orcid.org/0000-0002-6770-5916
25-SEP-2023
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