Randomized trial of IV dexamethasone for acute migraine in the emergency department

Friedman, Benjamin W.; Greenwald, Peter; Bania, Theodore C.; Esses, David; Hochberg, Michael L.; Solórzano, Clemencia; Corbo, Jill; Chu, Jason; Chew, Evelyn Al; Cheung, P.W.; Fearon, S.; Paternoster, Joseph; Baccellieri, A.; Clark, Sunday; Bijur, Polly E.; Lipton, Richard B.; Gallagher, E. John

doi:10.1212/01.wnl.0000281105.78936.1d

Cited by 106 publications

(90 citation statements)

References 24 publications

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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.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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%

“…One trial reported that 10 patients receiving dexamethasone reported an acute medication reaction; however, these reactions are not described. 37 Including these 10 reactions, dexamethasone-specific side effects were seen in 6% of the population. All of these reactions were considered transient and resolved without any additional therapy.…”

Section: Quantitative Data Synthesismentioning

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%

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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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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Quantitative Data Synthesismentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Las dosis que se han utilizado son ligeramente inferiores a las que se utilizan en el estatus convulsivo, y se administran mediante una infusión rápida [35][36][37][38][39][40] . Por tanto, lo recomendable en una crisis de migraña de larga duración o un estatus migrañoso es utilizar sumatriptán subcutáneo o bien la combinación de AINES con metoclopramida.…”

Section: Figura 3 A) Tc Cerebral Sin Contraste: Hemorragia Subaracnounclassified

Cefalea en urgencias

Toledo

Riverol

Martínez‐Vila

et al. 2008

Anales Sis San Navarra

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RESUMENLas cefaleas son un motivo común de consulta en los servicios de urgencias. La mayoría de los pacientes presentan cefaleas primarias (migraña y cefalea tensional), pero el dolor de cabeza puede ser el síntoma de una enfermedad que comprometa la vida del individuo como la hemorragia subaracnoidea. El abordaje diagnóstico del paciente con cefalea consiste en diferenciar los pacientes con cefalea primaria de los que presentan una etiología secundaria, valorar la necesidad de solicitar exploraciones complementarias y tratar adecuadamente el dolor. La anamnesis permite diferenciar las cefaleas primarias de las secundarias en la mayoría de los casos. Existen una serie de síntomas de alarma que obligan a excluir causas secundarias. En los pacientes con cefalea de inicio súbito, cuando se inicia por encima de los 50 años o en aquellos pacientes con exploración neurológi-ca anormal, debe sospecharse una etiología secundaria.Palabras clave. Dolor. Cefalea. Tratamientos. Emergencias. ABSTRACTHeadache is among the most frequent neurological symptoms in the Emergency department. Although most of the patients suffer from primary headaches (migraine), an acute headache might be the only symptom of a serious disease, such as subarachnoid haemorrhage. The physician's task is to make the diagnosis, carry out an appropriate selection of the patients who require further diagnostic evaluation and relieve the pain. An accurate history will identify most of the patients with secondary headaches. Clinicians should suspect secondary causes in sudden onset headache, headache in patients aged over 50 years, and also in those patients with abnormalities on neurological examination.

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Central Nervous System (CNS)

Sommer

Goldstein

2008

Wiley Encyclopedia of Clinical Trials

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Modern clinical trials have revolutionized the practice of neurology. This introduction examines some of the issues and challenges involved in therapeutic trials for six common conditions that affect the central nervous system (ischemic stroke, Alzheimer's disease, migraine headache, epilepsy, Parkinson's disease, and multiple sclerosis) and explores how trials in these areas influence clinical practice. Examples of ongoing trials in each of these areas are also identified.

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Randomized trial of IV dexamethasone for acute migraine in the emergency department

Abstract: A moderate dose of IV dexamethasone should not be administered routinely for the emergency department-based treatment of acute migraine, although it might be useful for patients with migraine lasting longer than 72 hours.

Cited by 106 publications

References 24 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

Cefalea en urgencias

Central Nervous System (CNS)

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