Efficacy of Parenteral Dexamethasone to Prevent Relapse after Emergency Department Treatment of Acute Migraine

Jones, Jenna

doi:10.1197/aemj.10.5.542

Cited by 11 publications

(27 citation statements)

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“…We also addressed headache severity at follow-up. By using the end points of "repeat physician visit" and "interfering with normal daily activities" we were able to compare our results with other ED studies 15,16,25 that used similar end points. The 58.3% headache recurrence rate at 48-72 hours follow-up for the placebo group is compatible with previous reported treatment failure rates of 6%-66%.…”

Section: Discussionsupporting

confidence: 53%

“…Class A and B were rated as "severe," and class C and D were classified as "mild" to allow for direct comparison to previous studies. 15,16,25 Finally, patients were asked to describe any unusual side effects. Our primary outcome was the percentage of patients that experienced headache recurrence at 48-72 hours.…”

Section: Measurements and Outcomesmentioning

confidence: 99%

“…[4][5][6] For purposes of ED headache treatment, there is usually little need to differentiate between these benign headache etiologies. 7,8 Although the acute symptoms can generally be relieved, 8%-66% of patients will suffer a recurrence within 48 hours, [9][10][11][12][13][14][15][16] and inflammation appears to play a critical role in these recurrences. [17][18][19][20] Therefore, prolonged suppression of this inflammatory process may be an important component of acute headache management.…”

Section: Introductionmentioning

confidence: 99%

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Intravenous dexamethasone to prevent the recurrence of benign headache after discharge from the emergency department: a randomized, double-blind, placebo-controlled clinical trial

Hunter

2006

CJEM

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Objective:To evaluate whether the addition of intravenous (IV) dexamethasone to standard emergency department (ED) benign headache therapy would reduce the incidence of headache recurrence at 48–72 hours.Methods:This randomized, double-blind, placebo-controlled clinical trial of adult patients presenting with the chief complaint of headache was conducted in the ED of 2 academic, urban Level 1 hospitals. Headache evaluation and therapy were determined by the treating physician, and, before discharge, patients were administered either 10 mg of IV dexamethasone or placebo. The treatment groups had similar baseline characteristics, abortive therapy, IV fluids and degree of pain relief achieved before discharge. Patients were contacted 48–72 hours following discharge and asked whether their headache was “better,” “worse” or “remained unchanged” when compared with their symptoms at discharge. Those whose headaches were “worse” or “unchanged,” and those who reported a return of headache after being pain free at discharge were considered to be treatment failures and classified as having had a recurrence. The patient's headache at follow-up was further categorized as severe (i.e., provoking another physician visit or interfering with daily activity) or mild (i.e., requiring self-medication or no treatment).Results:Fifty-seven patients met the inclusion criteria and 2 were lost to follow-up, leaving 55 for analysis. At follow-up, 9.7% (3/31) of those receiving dexamethasone had headache recurrence, versus 58.3% (14/24) of those receiving placebo (p< 0.001). Four dexamethasone recipients (12.9%) had severe headaches at follow-up compared with 8 (33.3%) in the placebo group (p= 0.14).Conclusions:In this study, IV dexamethasone reduced headache recurrence at 48–72-hour follow-up. Given its excellent safety profile and likely benefit, IV dexamethasone should be considered for ED headache patients after standard evaluation and therapy.

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Section: Discussionsupporting

confidence: 53%

Section: Measurements and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intravenous dexamethasone to prevent the recurrence of benign headache after discharge from the emergency department: a randomized, double-blind, placebo-controlled clinical trial

Hunter

2006

CJEM

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“…34,[37][38][39][40] Two scientific abstracts were included in the final analysis. 35,36 Six primary authors, including both scientific abstract authors, were successfully contacted for additional trial information, including further details regarding adverse events, method of randomization and blinding, and verification of headache relapse rates. [35][36][37][38][39][40] All seven of the included trials had a final Jadad score of 5, indicating acceptable methodology with respect to randomization, blinding, and description of withdrawals and dropouts.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[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.…”

mentioning

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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Supportive Care for the Cancer Patient

Vail

Thamm

Liptak

2020

Withrow and MacEwen's Small Animal Clinical Oncology

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Efficacy of Parenteral Dexamethasone to Prevent Relapse after Emergency Department Treatment of Acute Migraine

Cited by 11 publications

References 0 publications

Intravenous dexamethasone to prevent the recurrence of benign headache after discharge from the emergency department: a randomized, double-blind, placebo-controlled clinical trial

Intravenous dexamethasone to prevent the recurrence of benign headache after discharge from the emergency department: a randomized, double-blind, placebo-controlled clinical trial

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

Supportive Care for the Cancer Patient

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