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Dexamethasone Has No Benefit in Acute Migraine but Might Reduce Recurrence
A single parenteral dose of dexamethasone reduced recurrences within 72 hours by 26% compared with placebo.
Inflammation might contribute to acute migraine, and, therefore, corticosteroids could be a helpful treatment. Researchers performed a meta-analysis of seven randomized, controlled studies (involving 738 patients) that compared single-dose parenteral dexamethasone (10–24 mg) with placebo for treatment of acute migraine headache in adults who also received standard abortive therapy.
No differences in acute pain relief were noted between the dexamethasone and placebo groups. However, patients in the dexamethasone group were significantly less likely than those in the placebo group to have recurrent headache within 72 hours (39.9% vs. 29.6%; relative risk, 0.74). Incidences of adverse effects (including restlessness, drowsiness, tingling, numbness, and swelling) were similar between groups. The dexamethasone group was more likely to report dizziness than was the placebo group (RR, 2.15) and less likely to have nausea (RR, 0.70) or other adverse events (RR, 0.50). The authors conclude that when added to standard acute migraine treatment, a single parenteral dose of dexamethasone is associated with a 26% reduction in headache recurrence within 72 hours. An accompanying editorial notes that patients with diabetes should be treated with caution because of the potential for prolonged elevation of blood sugar.
Comment: Despite the limitations of a meta-analysis, these results suggest that a single dose of dexamethasone is a reasonable addition to the treatment of acute migraine episodes that has little downside for patients without contraindications to steroids. Although dexamethasone had no benefit for initial pain relief, the number needed to treat to prevent one recurrence was only 9, suggesting that treatment has significant potential to help patients remain functional and avoid repeat emergency department visits. This study tested only parenteral administration, but an oral dose might be just as effective in nonvomiting patients.
Published in Journal Watch Emergency Medicine July 11, 2008
Citation(s):
Colman I et al. Parenteral dexamethasone for acute severe migraine headache: Meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun 14; 336:1359.
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- Medline abstract (Free)
Evans RW. Treating migraine in the emergency department. BMJ 2008 Jun 14; 336:1320.
- Original article (Subscription may be required)
- Medline abstract (Free)