Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrenceBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39566.806725.BE (Published 12 June 2008) Cite this as: BMJ 2008;336:1359
- Ian Colman, assistant professor1,
- Benjamin W Friedman, assistant professor, emergency physician2,
- Michael D Brown, professor3,
- Grant D Innes, professor, head4,
- Eric Grafstein, emergency physician5,
- Ted E Roberts, assistant professor, director6,
- Brian H Rowe, professor, research director17
- 1School of Public Health, University of Alberta, Edmonton, AB, Canada
- 2Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- 3Department of Epidemiology and Program in Emergency Medicine, Michigan State University, Grand Rapids, MI, USA
- 4Division of Emergency Medicine, University of Calgary, AB, Canada
- 5Department of Emergency Medicine, Providence Health Care and St Paul’s Hospital, Vancouver, BC, Canada
- 6Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- 7Department of Emergency Medicine, University of Alberta, 1G1.42 Walter C Mackenzie Centre, 8440-112 Street, Edmonton, AB, Canada T6G 2B7
- Correspondence to: B H Rowe
- Accepted 11 April 2008
Objective To examine the effectiveness of parenteral corticosteroids for the relief of acute severe migraine headache and prevention of recurrent headaches.
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.
We thank the department of emergency medicine at the University of Alberta; ICN Pharmaceuticals and Faulding Pharmaceutical for responding to our requests for unpublished data; and A Bastani, a corresponding study author. Data from this study were reported at the Canadian Association of Emergency Physicians annual scientific meeting, Winnipeg, MB, Canada, 14-17 June, 2003.
Contributors: IC conceived the project, carried out the searches, coordinated the reviewers, collected and extracted the data, and prepared the manuscript. BWF interpreted and provided data. MDB contributed to the protocol and collected and extracted data. GDI contributed to the protocol, selected articles, and reviewed the manuscript. EG and TER contributed to the protocol and selected articles. BHR conceived the project, contributed to the protocol, coordinated the review, selected articles, collected and extracted data, prepared the manuscript, and secured project funding. All authors helped revise the manuscript. IC and BHR are guarantors for the paper.
Funding: BHR is supported by the 21st century Canada research chairs programme through the government of Canada. The Canadian Association of Emergency Physicians Research Consortium provided partial support for this study.
Competing interests: GDI, BWF, and BHR are primary authors of included trials. MDB and IC are coauthors of included trials.
Ethical approval: Not required.
Provenance and peer review: Not commissioned; externally peer reviewed.