Efficacy of parenteral dexamethasone to prevent relapse after emergency department treatment of acute migraine

OBJECTIVES: Studies indicate that up to 66% of migraine patients will suffer recurrent headaches after abortive therapy. Our objective was to evaluate the effectiveness of parenteral steroids in reducing the incidence of migraine headache recurrence 48 hours after discharge from the ED. METHODS: This was a randomized, double-blind, controlled trial of adult migraine patients evaluated in the ED of a community teaching hospital over a 24-month study period. Eligible patients met the International HeadacheSociety’s diagnostic criteria for migraine headache and hada headache severe enough to require parenteral therapy.After abortive therapy (antiemetics, analgesics), patients were administered either parenteral dexamethasone (20 mg/2mL) or placebo. Patients were contacted by telephone 48hours after discharge and asked whether they had suffered a recurrent headache. These were categorized as class A(provoking another physician visit), class B (interfering with daily activity but not provoking another physician visit),class C (requiring self-medication but not limiting daily activity) or class D (requiring no treatment). Discrete variables were analyzed with the chi-square test. RESULTS: Seventy-five patients met the inclusion criteria; five patients were lost to follow-up, leaving 70 in the study sample. The treatment groups were similar with regard to baseline characteristics, headache duration, and abortive therapy. At follow-up, 12% (4/34) of those receiving dexamethasone had severe (classes A and B) headache recurrence; 29% (10/34) had mild (classes C and D) recurrence; and 59% (20/34) had no recurrence. Similarly, 19% (7/36) in the placebo group had severe headache recurrence; 28% (10/36) had mild recurrence; and 53% (19/36) had no recurrence. These rates of recurrence were not statistically significant (p=0.675). CONCLUSIONS: These results suggest that parenteral dexamethasone does not decrease the incidence of recurrent headache following ‘‘successful’’ ED treatment.