BMJ, doi: 10.1136/bmj.39566.806725.BE, (Published 9 June 2008)

Research

Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence

¹ School of Public Health, University of Alberta, Edmonton, AB, Canada, ² Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA, ³ Department of Epidemiology and Program in Emergency Medicine, Michigan State University, Grand Rapids, MI, USA, ⁴ Division of Emergency Medicine, University of Calgary, AB, Canada, ⁵ Department of Emergency Medicine, Providence Health Care and St Paul’s Hospital, Vancouver, BC, Canada, ⁶ Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada, ⁷ Department of Emergency Medicine, University of Alberta, 1G1.42 Walter C Mackenzie Centre, 8440-112 Street, Edmonton, AB, Canada T6G 2B7

Objective To examine the effectiveness of parenteral corticosteroids for the relief of acute severe migraine headache and prevention of recurrent headaches.

Design Meta-analysis.

Data sources Electronic databases (Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, and CINAHL), conference proceedings, clinical practice guidelines, contacts with industry, and correspondence with authors.

Selection criteria Randomised controlled trials in which corticosteroids (alone or combined with standard abortive therapy) were compared with placebo or any other standard treatment for acute migraine in adults.

Review methods Two reviewers independently assessed relevance, inclusion, and study quality. Weighted mean differences and relative risks were calculated and are reported with 95% confidence intervals.

Results From 666 potentially relevant abstracts, seven studies met the inclusion criteria. All included trials used standard abortive therapy and subsequently compared single dose parenteral dexamethasone with placebo, examining pain relief and recurrence of headache within 72 hours. Dexamethasone and placebo provided similar acute pain reduction (weighted mean difference 0.37, 95% confidence interval –0.20 to 0.94). Dexamethasone was, however, more effective than placebo in reducing recurrence rates (relative risk 0.74, 95% confidence interval 0.60 to 0.90). Side effect profiles between dexamethasone and placebo groups were similar.

Conclusion When added to standard abortive therapy for migraine headache, single dose parenteral dexamethasone is associated with a 26% relative reduction in headache recurrence (number needed to treat=9) within 72 hours.

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This article has been cited by other articles:

• Carpenter, C. R (2009). Review: adding dexamethasone to standard therapy reduces short-term relapse for acute migraine in the emergency department. Evid. Based Med. 14: 121-121 [Full text]  
• (2008). Dexamethasone Has No Benefit in Acute Migraine but Might Reduce Recurrence. JWatch Emergency Med. 2008: 2-2 [Full text]  
• Evans, R. W (2008). Treating migraine in the emergency department. BMJ 336: 1320-1320 [Full text]  

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