Steroids for migraine Best Bet

Migraine Barbie from Migraine Chick on Flickr (CC License)

Migraine Barbie from Migraine Chick on Flickr (CC License)

Shameless self-promotion here but a Best Bet written by myself and @dreapadoirtas of underneathEM just got published in the EMJ this month.

If you’re a FOAM follower then you’ll probably already heard that a dose of dex can reduced the rate of recurrence of migraine in ED patients. There’s an NNT of about 10.

The short paper can be found on the EMJ website [access required]. It’ll be on Pub Med soon.

About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician @andyneill | + Andy Neill | Contact

Comments

  1. Don’t have access -- so I couldn’t see the paper. The conclusion (ie, NNT=10) is similar to my impressions from prior literature. KEY point I believe is that this means for every 10 ED patients given Dexamethasone -- 9 of them get no benefit. I of course would not care that 9 other patients got no benefit if I had severe migraine and I was the 1 out of 10 who did benefit -- but I think it important to be aware of the relative chance for benefit vs no benefit. Fortunately -- chance of adverse effect from single dose Dexamethasone is small.

  2. P.S. CONGRATS Andy for getting your “Best Bet” published! -- : )

  3. P.P.S. Just got to see the “Best Bet” you published. NICE job -- and I DO agree with your “Clinical Bottom Line” -- namely that “patients who have received successful abortive treatment for migraine in the ED should be considered for a single dose of IV dexamethasone before discharge to reduce the risk of recurrence in the absence of contraindications to steroid therapy.” I’d add the implied message -- that a patient who has already responded to IV Dexamethasone may be more likely to respond again (though use of prophylactic therapy clearly favored if recurrence is frequent).

    NICE job Andy! (btw -- there is a typo misspelling of “does” instead of “dose” in the clinical bottom line …. ).

  4. You can see it here

    http://emj.bmj.com/content/30/2/165.extract
    OR
    here on the BestBets website -- http://bestbets.org/bets/bet.php?id=2333

    S

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