There is a multitude of different pharmacological options currently prescribed for acute care of migraine.[11] Of all pharmacological agents, triptans are highly selective, migraine-specific drugs targeting the serotonergic receptors.[12] They have 3 major mechanisms of buy Everolimus action: vasoconstriction of dilated meningeal blood vessels, blockage of nociceptive transmission in the trigeminal system, and possibly prevention of development of central sensitization.[1, 13] Thus, they are considered as the first-line therapy for mild to moderate attacks unresponsive to nonspecific analgesics.[13] The first 5-hydroxytryptamine

(serotonin) agonist, sumatriptan, was a major advance in antimigraine therapy when it was introduced in 1991. Sumatriptan results in 70-80% pain relief 2 hours after administration.[14] Although sumatriptan is effective in many migraineurs, it is relatively expensive and contraindicated in patients with cardiovascular disease and respiratory compromise.[15] Combination therapy of migraine attacks appeared to be more efficient than single drug treatment especially in reducing pain recurrence.[16] Currently, phenothiazines have received more attention as less expensive monotherapy to relieve pain and the common associated symptoms of

nausea and vomiting. Their mechanism of action includes blockade of the central dopamine (D2) receptors specifically D2-mediating meningeal artery vasodilatation.[17, 18] Promethazine is a phenothiazine antihistamine, endowed with sedative and antiemetic properties.[18] The efficacy of the concurrent use of sumatriptan and other pharmaceutical interventions for the treatment of migraine has Pirfenidone cell line recently been established in clinical trials.[19, 20] Nevertheless, to date, the advantage of combination therapy with sumatriptan plus promethazine (SPr) has not been studied in the treatment of moderate to severe migraine

headache. This study was, therefore, designed to evaluate the efficacy and safety of oral SPr in subjects suffering from migraine headaches with or without aura. This was a multicenter, double-blind, randomized trial conducted on an outpatient basis at 5 university-affiliated primary and secondary medchemexpress care centers in Iran. The study centers were 4 general neurology hospitals and 1 general medicine hospital outpatient clinic. The trial was conducted in compliance with the International Conference on Harmonization Guidelines for Good Clinical Practice[21] and the Declaration of Helsinki.[22] The protocol was reviewed and approved by the local review board or ethics committee at each investigative site, and the final study protocol was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (SUMS). Written informed consent was obtained from all patients. Patients were enrolled on a rolling basis from January 2013 to April 2013. A total of 350 consecutive patients were screened for the study, and 242 subjects were enrolled.