A Randomized Trial of Intravenous Dexamethasone for Acute Migraine in the Emergency Department

Friedman, Bruce; Greenwald, Peter; Bania, Theodore C.; Hochberg, Michael L.; Solorzano, C.; Corbo, Jill; Chu, Jason; Chew, Evelyn Al; Baccillieri, A.; Clark, S.; Bijur, Polly E.; Lipton, RB; Gallagher, E. John

doi:10.1197/j.aem.2007.03.895

Cited by 2 publications

(3 citation statements)

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“…[11][12][13][14][15][16][17][18][19] Although initial controlled clinical trials demonstrated the same high-level of efficacy, [20][21][22][23][24][25][26] the results of several recent ED-based trials have questioned the utility of dexamethasone for this purpose. [27][28][29][30][31][32][33][34][35][36][37][38][39][40] The goals of this systematic review were to critically appraise the existing literature and to provide recommendations for patient care regarding the use of dexamethasone for the prevention of headache relapse in patients with acute migraine headache in the ED. Our primary outcome of interest was the proportion of migraine patients with self-reported symptoms of moderate or severe headache at 24-to 72-hour follow-up evaluation.…”

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confidence: 99%

Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta‐analysis and Systematic Review of the Literature

Singh

Alter

Zaia

2008

Academic Emergency Medicine

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Objectives: Neurogenic inflammation is thought to play a role in the development and perpetuation of migraine headache. The emergency department (ED) administration of dexamethasone in addition to standard antimigraine therapy has been used to decrease the incidence of recurrent headaches at 24 to 72 hours following evaluation. This systematic review details the completed trials that have evaluated the use of dexamethasone in this role. Methods:The authors searched MEDLINE, EMBASE, CINAHL, LILACS, recent emergency medicine scientific abstracts, and several prepublication trial registries for potential investigations related to the research question. The authors included studies that incorporated randomized, double-blind, placebocontrolled methodology and that were performed in the ED. A fixed-effects and random-effects model was used to obtain summary risk ratios (RRs) and 95% confidence intervals (CIs) for the self-reported outcome of moderate or severe headache on follow-up evaluation.Results: A pooled analysis of seven trials involving 742 patients suggests a modest but significant benefit when dexamethasone is added to standard antimigraine therapy to reduce the rate of patients with moderate or severe headache on 24-to 72-hour follow-up evaluation (RR = 0.87, 95% CI = 0.80 to 0.95; absolute risk reduction = 9.7%). The treatment of 1,000 patients with acute migraine headache using dexamethasone in addition to standard antimigraine therapy would be expected to prevent 97 patients from experiencing the outcome of moderate or severe headache at 24 to 72 hours after ED evaluation. The sensitivity analysis yielded similar results with sequential trial elimination, indicating that no single trial was responsible for the overall result. Adverse effects related to the administration of a single dose of dexamethasone were infrequent, mild, and transient. Conclusions:These results suggest that dexamethasone is efficacious in preventing headache recurrence and safe when added to standard treatment for the management of acute migraine headache in the ED.ACADEMIC EMERGENCY MEDICINE 2008; 15:1223-1233

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confidence: 99%

Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta‐analysis and Systematic Review of the Literature

Singh

Alter

Zaia

2008

Academic Emergency Medicine

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“…Neurogenic inflammation has been hypothesised as playing a role in this process,6 – 9 and small studies10 – 14 have suggested that intravenous dexamethasone can reduce its occurrence. Subsequent ED studies (only available in abstract form) have failed to confirm this 15 – 17. There are two main issues with these studies.…”

Section: Discussionmentioning

confidence: 99%

“…This is supported by a small ED-based randomised controlled trial comparing intravenous adjuvant dexamethasone with placebo after treatment of migraine in the ED. A marked reduction in the rate of recurrent headache was observed with intravenous dexamethasone (10% vs 58%)14 but subsequent reports, only available in abstract form, have failed to confirm this finding 15 – 17. The main weakness of these studies is that, with one exception, they fail to control for initial ED treatment.…”

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confidence: 99%

Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomised controlled trial

Kelly

Kerr

Clooney

2008

Emergency Medicine Journal

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A Randomized Trial of Intravenous Dexamethasone for Acute Migraine in the Emergency Department

Cited by 2 publications

References 0 publications

Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta‐analysis and Systematic Review of the Literature

Does the Addition of Dexamethasone to Standard Therapy for Acute Migraine Headache Decrease the Incidence of Recurrent Headache for Patients Treated in the Emergency Department? A Meta‐analysis and Systematic Review of the Literature

Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomised controlled trial

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