*3.5.3 Ergots*

Ergots containing active constituent ergotamine. It is available in combination with caffeine. Ergotamine is most effective for the pain which lasts more than 72 h but it is less effective than triptans. Migraine related nausea and vomiting may

get worse because of ergotamine. Overuse of ergotamine also leads to headache. Dihydroergotamine is comparatively more effective than ergotamine and have fewer side effects [53].

#### *3.5.4 Anti-emetics*

Headaches are mostly associated with nausea and vomiting especially in case of migraine. Anti-emetic medications such as metoclopramide, chlorpromazine and prochlorpromazine are given in combination with other medication to prevent nausea and vomiting.

### *3.5.5 Steroids (glucocorticoids)*

Glucocorticoids such as dexamethasone are used in combination with other headache medication in order to reduce pain severity. Steroids should be used with caution because it causes steroidal toxicity [54, 55].

### **3.6 Sinusitis or migraine**

Sinusitis related headaches and migraine are mostly confused with each other in term of diagnosis because signs and symptoms of both ailments are overlapped each other. In both type of headaches, condition become worse when individual bend forward. However in migraine there are also nasal disorders such nasal congestion, stuffy filled nose with watery discharge and facial pressure. Due to these symptoms migraine is mistakenly taken as sinusitis related headache by 90% of the patients. Whereas in case of sinus headache there is no nausea and vomiting which is usually common in migraine. Duration of sinus related headache is from 7 days or even longer however, migraine may last from hours to 1 or 2 days [56, 57].
