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Published online before print October 17, 2007, doi:10.1212/01.WNL.0000281105.78936.1d)
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NEUROLOGY 2007;69:2038-2044
© 2007 American Academy of Neurology

Randomized trial of IV dexamethasone for acute migraine in the emergency department

B. W. Friedman, MD, MS, P. Greenwald, MD, T. C. Bania, MD, MS, D. Esses, MD, M. Hochberg, MD, C. Solorzano, RPh, J. Corbo, MD, J. Chu, MD, E. Chew, MD, P. Cheung, MPH, S. Fearon, BS, J. Paternoster, RN, A. Baccellieri, MD, S. Clark, ScD, P. E. Bijur, PhD, R. B. Lipton, MD and E. J. Gallagher, MD

From the Departments of Emergency Medicine (B.W.F., D.E., M.H., J. Corbo, E.C., S.F., J.P., A.B., P.E.B., E.J.G.), Neurology (R.B.L.), and Epidemiology and Population Health (P.E.B., R.B.L., E.J.G.), Albert Einstein College of Medicine, and Pharmacy Department, Montefiore Medical Center (C.S.), Bronx; Division of Emergency Medicine, New York Presbyterian Hospital (P.G., P.C., S.C.); and Department of Emergency Medicine (T.C.B., J. Chu), St. Lukes-Roosevelt Medical Center, New York, NY.

Address correspondence and reprint requests to Dr. Benjamin W. Friedman, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467 befriedm{at}montefiore.org

Background: It is not yet clear if corticosteroids are useful for the treatment of migraine. We determined the efficacy of 10 mg of IV dexamethasone as adjuvant therapy for patients presenting to an emergency department (ED) with acute migraine.

Methods: This was a randomized, double-blind, placebo-controlled multicenter trial. Subjects were randomized to dexamethasone 10 mg IV or placebo. As primary treatment for their migraine, all subjects received IV metoclopramide. Our primary hypotheses were the following: a greater percentage of patients with migraine who received dexamethasone would 1) achieve a headache-free state in the ED and maintain it for 24 hours and 2) have no headache-related functional impairment after ED discharge when compared to placebo.

Results: A total of 656 patients were approached for participation and 205 were randomized. The persistent pain-free outcome was achieved in 25% of those randomized to dexamethasone and 19% of placebo (p = 0.34). No functional impairment after ED discharge occurred in 67% of those randomized to dexamethasone and 59% of placebo (p = 0.20). In the subgroup of subjects with migraine lasting longer than 72 hours, 38% of those randomized to dexamethasone were persistently pain-free vs 13% of placebo (p = 0.06). Side effect profiles were similar, with the exception of acute medication reactions, which occurred more commonly in the dexamethasone group.

Conclusion: A moderate dose of IV dexamethasone should not be administered routinely for the emergency department–based treatment of acute migraine, although it might be useful for patients with migraine lasting longer than 72 hours.

Abbreviations: ED = emergency department; NNT = number needed to treat.

Formula

Editorial, page 2034

e-Pub ahead of print on October 17, 2007, at www.neurology.org.

Dr. Friedman is supported through a K23 career development award (1K23NS051409-01A1) from National Institute of Neurological Disorders and Stroke.

Disclosure: The authors report no conflicts of interest.

Received November 1, 2006. Accepted in final form March 9, 2007.




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