I’ve spoken to two neurologists about this and neither had even heard of this idea, never mind tried it. I suppose there’s still a bit of a gap between ED research and the specialties.
I first heard on this on EMA (back when i could afford the subscription…).
In patients with migraine in the ED, once resolution has been acheived, treatment with steroid reduces the risk of short-term recurrence of migraine.
The two met-analyses I’ve seen on it (below) both come up with an NNT of around 10 or so.
I do this with most migraine patients I see these days. Single dose of 10mg IV usually.
Anyone else doing this? Any favourites for migraine?
1. Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta-analysis and Systematic Review of the Literature. Academic Emergency Medicine. 2008;15(12):1223–1233.
2. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ. 2008;336(7657):1359–1361.