2020;35:628C632.. obtaining, but issued a correction shortly thereafter, stating that there was no scientific evidence supporting this claim. The United States Food and Drug Administration, European Medicines Agency, and Spanish Agency of Medicines and Medical Devices have issued statements to the same effect, and recommend that research be done on the subject.14, 15, 16 The possible association between exacerbation of SARS-CoV-2 contamination and treatment with ibuprofen and ketoprofen is being evaluated by the Western Medicines Agencys Pharmacovigilance Risk Assessment Committee. In rats, ibuprofen increases ACE2 levels in the heart only; this effect has not been observed in other organs.8, 17 It should be noted that this dose used in the experimental animals is equivalent to 3?g in humans, whereas the maximum recommended dose for migraine treatment is 1800?g/day.4 Therefore, we recommend avoiding new indication of ibuprofen only in patients with migraine and presenting risk factors for severe COVID-19 (Table 1). In patients Noopept already using the drug, we do not recommend changing the treatment, although physicians should advise patients to avoid extra consumption of ibuprofen (more than 15 pills/month). It should also be noted that alternative drugs are available Noopept for treating moderate migraine attacks; these include naproxen, indometacin, and diclofenac. Finally, triptans can also be used: these drugs are indicated for moderate-severe migraine attacks. Corticosteroids Corticosteroids are indicated as a transitional preventive treatment for cluster headache and for the treatment of status migrainosus (level of evidence 4 and grade of recommendation C for both indications).4 Indication of these drugs to treat COVID-19 is controversial. The United States Centers for Disease Control and Prevention contraindicate corticosteroids based on previous experience with the 2003 SARS-CoV epidemic, when several articles reported that early use of corticosteroids was associated with higher plasma viral weight and delayed viral clearance.18 However, they may Noopept be beneficial ActRIB in the early stage of SARS-CoV-2 infection, reducing the duration of mechanical ventilation and overall mortality rates in patients with Noopept established moderate-to-severe adult respiratory distress syndrome19; no randomised studies have been performed, however.20 As corticosteroids are known to cause immunosuppression, we recommend avoiding the habitual indication of 1 1?mg/kg orally in patients with cluster headache during the pandemic and extending the use of occipital nerve block with triamcinolone, methylprednisolone, or betamethasone; these drugs have the same level of evidence and practically no systemic effects, since the corticosteroid is usually injected locally. 4 Clinical guidelines also mention other treatment options for delayed preventive treatment, including verapamil (level of evidence 1, grade of recommendation A), lithium carbonate (level of evidence 2, grade of recommendation B), topiramate (level of evidence 2, grade of recommendation B), valproic acid (level of evidence 4, grade of recommendation C), gabapentin (third-line treatment), and botulinum toxin A.4 Parenteral or oral corticosteroids are also used to treat status migrainosus in emergency departments4; however, as they are prescribed for very short schedules, we do not recommend avoiding them, except in cases of strong suspicion or diagnosis of severe COVID-19 (Table 1). Carbamazepine Carbamazepine is usually indicated for the treatment of trigeminal neuralgia, with level of evidence 1 and grade of recommendation A.4 No study has addressed the relationship between the drug and COVID-19; however, given that its potential adverse effects include leukopaenia, we recommend considering other options before indicating it as a new treatment, especially in patients with risk factors for severe COVID-19 (Table 1). COVID-19 typically presents with lymphocytopaenia, which may be exacerbated by carbamazepine-induced leukopaenia. Patients not presenting risk factors for severe COVID-19 (Table 1) and who have already been receiving the drug for over 3 months Noopept should be monitored with laboratory blood analyses. This recommendation should also be extended on an individual basis to patients with trigeminal neuralgia taking sodium channel blockers: eslicarbazepine acetate, oxcarbazepine (level of evidence 4, grade of recommendation C), and lamotrigine (level of evidence 2, grade of recommendation B). Other treatment options are.