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Treating migraine in the emergency department

BMJ 2008; 336 doi: (Published 12 June 2008) Cite this as: BMJ 2008;336:1320
  1. Randolph W Evans, clinical professor of neurology
  1. 1Baylor College of Medicine, Houston, TX 77004, USA
  1. rwevans{at}

Corticosteroids do not relieve acute pain but do reduce recurrence

In the accompanying systematic review, Colman and colleagues assess the effectiveness of parenteral corticosteroids for treating acute severe migraine and preventing recurrence.1 In Western Europe and the United States, about 12% of adults experience migraine each year, and 63% of these people have one to four migraines a month. Most people have nausea and moderate to severe pain, which results in severe impairment or requires bed rest, and one third have vomiting.2 If untreated, these headaches last for four to 72 hours, with a median duration of 24 hours.

In the US, only 56% of affected patients have received a medical diagnosis of migraine and instead believe that they have sinus, tension, or stress headache. About half of these people use over the counter drugs,3 which are effective in up to 59% of cases. But even with seven different types of triptans and various ways of giving them, 25% of patients do …

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