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.
UPDATE: I have since managed to get a Best Bet published on this with Domhnall Brannigan
I’ve used dexamethasone for reduction of ‘rebound’ migraine the next day for a few years (based on the study you’ve quoted).
My standard for acute migraines is neat chlorpromazine – I don’t dilute it in 1L NS because the pt wants the migraine fixed now, not in a few hours when the bag is finally through. Theoretical postural hypotension is treated by sending pt to their partner’s car in a wheelchair.
I’m finding that regular topiramate nightly is excellent for prophylaxis, and rizatriptan wafers (or sumatriptan nasal spray) is excellent for the early acute attack.
Our protocol has the chlorpromazine toward the end of the list and in half litre of saline. It’s good to hear the hypotension isn’t that big a deal
I’ve seen our neurologist used topiramate regularly and he says with good effect
Pingback: The LITFL Review 024 - Life in the FastLane Medical Blog