Clinical QuestionDoes administration of intravenous dexamethasone as part of standard acute migraine treatment reduce migraine recurrence?
Evidence-Based AnswerAddition of intravenous dexamethasone to standard abortive therapy in the acute management of migraines reduces recurrence at 48-72 hours. Strength of Recommendation [SOR] is A, based on consistent results of three meta-analyses. Migraine recurrence may be associated with incomplete relief of migraine symptoms at initial presentation. ([SOR]: B, based on one small randomized control trial).
MethodologyA systematic review was performed in the PubMed database using the keywords "migraine treatment", "steroids and migraine treatment", and "dexamethasone and migraine recurrence". Only meta-analyses and randomized control trials (RCTs) were included. The bibliographies of the meta-analyses also were reviewed for RCTs fitting search criteria. Finally, only articles reporting patient-centered outcomes (including reduced morbidity, reported symptom improvement, improved quality of life, and lower cost) in the acute setting (24-72 hours) were included.
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