Status Migrainosus in Children and Adults

Chua, Abigail L.; Grosberg, Brian M.; Evans, Randolph W.

doi:10.1111/head.13676

Cited by 5 publications

(3 citation statements)

References 97 publications

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“…Some have suggested that corticosteroids are more likely to be of benefit among these patients. 25 Although the focus of this study was not status migrainosus, about one-fourth of our sample reported headache duration >72 hours. Yet even after controlling for headache duration, we did not identify any impact of the higher dose.…”

Section: Discussionmentioning

confidence: 83%

Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine

Friedman,

Solorzano,

Kessler

et al. 2023

Neurology

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Background.Dexamethasone decreases the frequency of migraine recurrence after emergency department (ED) discharge. However, the optimal dose of dexamethasone is unknown. We hypothesized that dexamethasone 16mg IV would allow greater rates of sustained headache relief than 4mg when co-administered with metoclopramide 10mg IV.Methods.This was a randomized double-blind study. Adults who presented with a headache meeting ICHD3 migraine criteria were eligible if they rated the headache as moderate or severe in intensity. Pain intensity was assessed for up to two hours in the ED and by telephone 48 hours and 7 days later. The primary outcome was sustained headache relief. Secondary outcomes included headache relief within two hours and number of headache days during the subsequent week. Relying on a priori criteria, the data safety monitoring committee recommended halting the study early for futility.Results.1823 patients were screened and 209 were randomized. The mean age was 38 years (SD- 11). 179/209 (86%) identified as women. 151/209 (72%) of the population reported severe intensity; the rest reported moderate. 35/102 (34%) participants in the metoclopramide +4mg arm achieved sustained headache relief as did 42/102 (41%) of participants in the metoclopramide +16mg arm (95%CI for absolute difference of 7%: -6, 20%). Headache relief within two hours occurred in 77/104 (74%) low dose and 82/ 105 (78%) high dose participants (95%CI for absolute difference of 4% = -8, 16%). During the week after ED discharge, low dose participants reported a median of 2 headache days (25th, 75thpercentile: 1,5); in the high dose arm this was also 2 (25th, 75thpercentile: 0,4) (95%CI for mean difference of 0.4: -0.3, 1.2).Conclusions.When added to 10mg IV metoclopramide, doses of dexamethasone greater than 4mg are unlikely to benefit patients in the ED with migraine.Trial registration information.This study was registered at clinicaltrials.govon Oct 2, 2019 (NCT04112823). The first patient was enrolled Dec 22, 2019.Classification of evidence.This study provides Class 1 evidence that 16mg of IV dexamethasone is unlikely to provide greater rates of sustained headache relief than 4mg of IV dexamethasone among patients in the ED with migraine treated concurrently with IV metoclopramide.

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Section: Discussionmentioning

confidence: 83%

Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine

Friedman,

Solorzano,

Kessler

et al. 2023

Neurology

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“…El uso de corticoides en la población general ha sido recomendado para el estatus migrañoso como coadyuvante analgésico y en migraña crónica para disminuir las cefaleas de rebote (57,63). Un estudio retrospectivo (64) reportó que el uso de corticoides durante el primer trimestre genero un aumento pequeño en la frecuencia de labio paladar hendido (OR: 1,7, IC: 1,1-2,6), siendo la prednisolona la de mayor riesgo.…”

Section: Corticoidesunclassified

Tratamiento agudo de la migraña durante el embarazo

2023

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INTRODUCCIÓN La migraña es una condición médica prevalente y altamente discapacitante. Por lo general, durante el embarazo hay una reducción de los síntomas migrañosos, sin embargo, en ocasiones la sintomatología puede no mostrar mejoría, y en algunos casos empeorar. Por tanto, es necesario que el médico del servicio de urgencias realice un correcto diagnóstico de esta enfermedad, que descarte otros tipos de cefaleas y brinde el mejor y el más seguro tratamiento analgésico de acuerdo con la edad gestacional y perfil clínico de cada paciente. En esta revisión se abordará la relación entre la migraña y el embarazo, el papel de los estrógenos en la génesis de la migraña, así como también los datos más actuales en cuanto al tratamiento del manejo agudo de esta patología durante la gestación. MATERIALES Y METODOS: Se realizó una revisión sistemática de la literatura mundial sobre la relación entre la migraña y el embarazo y el manejo agudo en esta población, obteniéndose un total de 83 referencia bibliográficas. RESULTADOS: Como manejo inicial, se recomienda el uso de Acetaminofén más metoclopramida en cualquier etapa de la gestación. El uso de AINE debe evitarse a partir de la semana 20 de gestación. El Sumatriptán puede ser utilizado como segunda línea en cualquier trimestre. A todas las pacientes se les debe brindar manejo no farmacológico. CONCLUSIONES: Actualmente se cuenta con varios medicamentos y procedimientos seguros para el manejo agudo de la migraña en gestantes, sin embargo, debe tenerse en cuenta la edad gestacional ante su administración.

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“…Though the pathophysiology of SMg is largely unknown, some risk factors including psychiatric comorbidities (i.e., depression and anxiety) and daily-life stressors have been identified [ 4 ]. Treatment of SMg is challenging and lacks international consensus.…”

Section: Introductionmentioning

confidence: 99%