Dr Jitka Pokladnikova and colleagues of Charles University in Prague reviewed the World Health Organization's global database and other sources and found an unexpected cluster of 38 cases of migraine suspected to be related to the use of intranasal corticosteroids. The suspected drugs included six different drugs: fluticasone, beclometh-asone, budesonide, mometasone, flunisolide, and triamcinolone. In 24 cases the intranasal corticosteroid was the only drug used, the researchers report in the medical journal Cephalalgia.

Re-exposure to the intranasal corticosteroid led to a relapse of migraine in eight patients. None of the drugs exceeded the maximum daily recommended dose range in any reported case. In the 16 reports where time to onset was recorded, migraine developed early in the course of intranasal corticosteroid treatment in 12 cases — within the first four days.

John adds: I recently discovered this myself, through painful personal experience! I was getting a migraine every day and couldn't work out why – never suspecting the flunisolide spray I was using to control my allergic catarrh. Then I read this and, when I stopped using the spray, the migraines also stopped! Now I only use nasal irrigation!

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May 2009

First Published in May 2009

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