Dexamethasone for migraine headaches: an emergency department randomized double-blind placebo-controlled trial.

BACKGROUND: Recurrence of headache after treatment for migraines in the emergency department (ED) is common. Conflicting evidence exists regarding the utility of dexamethasone to prevent headache recurrence at 24-48 hours. OBJECTIVE: To determine if dexamethasone added to standard treatment decreases the recurrence of headaches in patients treated for migraine headache in the ED. METHODS: DESIGN: Double-blind placebo-controlled randomized trial. PARTICIPANTS: Patients >17 years of age with an initial pain score >5 (10-point visual analog scale [VAS]), ED clinical diagnosis of migraine headache, and presentation requiring intravenous (IV) therapy. The study was performed at a suburban community hospital with an annual volume of 70,000 visits from May 2003 to November 2005. PROTOCOL: Patients received standard medical treatment for their headaches. Informed consent was then obtained. Enrolled patients received either dexamethasone (10 mg IV) or a placebo (similar-appearing saline infusion). Demographic and historical information was collected utilizing a standardized closed-question form. Patients were contacted 24-48 hours after the ED visit by study authors. The primary study end point was the recurrence of headache at follow-up. Chi-square was used for the main study outcome with a preset alpha of 0.05. A pre-enrollment power calculation determined that 44 patients were needed in each group (alpha 0.05, and power of 80%).RESULTS: A total of 91 patients were enrolled. Six were lost to follow-up: 2 in the dexamethasone group and 4in the placebo group. Participants had a mean age of 38±10 years, with 90% females. 92% met the International Headache Society criteria for migraine headache.Of the 85 patients with complete data, 19/44 (43%) in the dexamethasone arm and 20/41 (49%) in the placebo arm had recurrent headache upon follow-up (p = 0.60). CONCLUSIONS: Dexamethasone (10 mg IV) does not appear to decrease headache recurrence in patients treated for migraine headache in the ED.