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.
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.
P.S. CONGRATS Andy for getting your “Best Bet” published! – : )
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 …. ).
yeah there’s a few more typos in there than i’d like!!!
You can see it here
here on the BestBets website – http://bestbets.org/bets/bet.php?id=2333