Does Addition of Dex in ED Treatment Reduce Migraine Recurrence?
- Sep 8th, 2014
- Meaghan Dehning
- Migraines affect 1/5 adults in US
- 5th most common ED visit1
- Affects 18% of women and 6% of men in US
- Associated with $17 billion/yr health care related cost
- 5-11% of pts return to the ED with symptoms
- Symptom recurrence can be reduced by using a combination of standard abortives and dexamethasone.
- A 2013 meta-analysis in which eight studies with a combined 905 patients showed that addition of steroids to a standard abortive can reduce the rate of recurrence with a RR of .71 (95%CI 0.59-0.86). The authors also noted that there was no benefit in administration of steroids after migraine resolution.
- A 2011 RCT placebo study looked at the efficacy of steroids in preventing migraine recurrence and found that steroids did not prevent the recurrence of migraines.
- A 2007 study examined the efficacy of 10mg IV dexamethasone in ED migraine management. Patients were randomized to dexamethasone or placebo. 25% of patients who received dexamethasone and 19% of placebo patients were pain-free (p=.34). In patients with migraines lasting longer than 72 hours 38% of dexamethasone patients and 13% of placebo patients were pain free (p=.06). The study’s authors concluded that dexamethasone should not be used unless the migraine has lasted greater than 72 hours. 
- A systematic review from 2008 showed a benefit when using dexamethasone to reduce the rate of migraine recurrence at 24 and 72 hour follow-up (RR=.87, ARR 9.7%). The study concluded that the minor and infrequent adverse reactions coupled with demonstrated benefit make dexamethasone a viable ED option to prevent recurrence.
Based on the current available data and relative low risk of dexamethasone it is not unreasonable to add this therapy to ED migraine management.