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).
Fluticasone propionate is a highly selective agonist at the glucocorticoid receptor with negligible activity at androgen , estrogen , or mineralocorticoid receptors , thereby producing anti-inflammatory and vasoconstriction effects. It has been shown to have a wide range of inhibitory effects on multiple cell types (. mast cell , eosinophil , neutrophil , macrophages , and lymphocytes ) and mediators (. histamine , eicosanoids , leukotrienes , and cytokines ) involved in inflammation . Fluticasone propionate is stated to exert a topical effect on the lungs without significant systemic effects at usual doses, due to its low systemic bioavailability .
Initial dose based on previous asthma drug therapy and disease severity; 100 mcg via oral inhalation once daily is the usual recommended starting dose for patients not on an inhaled corticosteroid. After 2 weeks of therapy, if asthma symptoms are uncontrolled, increase dose to 200 mcg via oral inhalation once daily. Max: 200 mcg once daily. Administer at the same time each day. The maximum beneficial effect may not be achieved for up to 2 weeks or longer after starting treatment. Titrate to the lowest effective dose once asthma stability is achieved.