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Evidence summaries

Parenteral Dexamethasone for Acute Severe Migraine Headache

Single-dose parenteral dexamethasone reduces migraine recurrence within 72 hours but does not reduce the initial headache. Level of evidence: "A"

A systematic review 1 including 7 studies with a total of 738 subjects was abstracted in DARE. The patients had acute severe migraine headache. The addition of i.m. or i.v. dexamethasone at doses of 10, 15, 20 or 24 mg to standard abortive care (numerous cointerventions were used) reduced the recurrence of migraine 24 to 72 h after treatment compared with placebo (RR 0.74, 95% CI 0.60 to 0.90) but did not influence initial headache pain reduction (4 studies, n=455, 95% CI -0.20 to 0.94). For the outcome of recurrent migraine, no significant differences were found between i.m. and i.v. administration of dexamethasone. Patients treated with dexamethasone were more likely to have dizziness (6 studies, n=626, RR 2.15, 95% CI 0.98 to 4.74), but less likely to have other adverse events (RR 0.50, 95% CI 0.30 to 0.82).

References

  • Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, Rowe BH. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008 Jun 14;336(7657):1359-61. [PubMed] [DARE]

Primary/Secondary Keywords