title: Randomized trial of IV dexamethasone for acute migraine in the emergency department.
abstract: BACKGROUND
  It is not yet clear if corticosteroids are useful for the treatment of migraine. We determined the efficacy of 10 mg of IV dexamethasone as adjuvant therapy for patients presenting to an emergency department (ED) with acute migraine.
  
  
  METHODS
  This was a randomized, double-blind, placebo-controlled multicenter trial. Subjects were randomized to dexamethasone 10 mg IV or placebo. As primary treatment for their migraine, all subjects received IV metoclopramide. Our primary hypotheses were the following: a greater percentage of patients with migraine who received dexamethasone would 1) achieve a headache-free state in the ED and maintain it for 24 hours and 2) have no headache-related functional impairment after ED discharge when compared to placebo.
  
  
  RESULTS
  A total of 656 patients were approached for participation and 205 were randomized. The persistent pain-free outcome was achieved in 25% of those randomized to dexamethasone and 19% of placebo (p = 0.34). No functional impairment after ED discharge occurred in 67% of those randomized to dexamethasone and 59% of placebo (p = 0.20). In the subgroup of subjects with migraine lasting longer than 72 hours, 38% of those randomized to dexamethasone were persistently pain-free vs 13% of placebo (p = 0.06). Side effect profiles were similar, with the exception of acute medication reactions, which occurred more commonly in the dexamethasone group.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. befriedm@montefiore.org
authors.forename: B W
authors.initials: BW
authors.lastname: Friedman
authors.forename: P
authors.initials: P
authors.lastname: Greenwald
authors.forename: T C
authors.initials: TC
authors.lastname: Bania
authors.forename: D
authors.initials: D
authors.lastname: Esses
authors.forename: M
authors.initials: M
authors.lastname: Hochberg
authors.forename: C
authors.initials: C
authors.lastname: Solorzano
authors.forename: J
authors.initials: J
authors.lastname: Corbo
authors.forename: J
authors.initials: J
authors.lastname: Chu
authors.forename: E
authors.initials: E
authors.lastname: Chew
authors.forename: P
authors.initials: P
authors.lastname: Cheung
authors.forename: S
authors.initials: S
authors.lastname: Fearon
authors.forename: J
authors.initials: J
authors.lastname: Paternoster
authors.forename: A
authors.initials: A
authors.lastname: Baccellieri
authors.forename: S
authors.initials: S
authors.lastname: Clark
authors.forename: P E
authors.initials: PE
authors.lastname: Bijur
authors.forename: R B
authors.initials: RB
authors.lastname: Lipton
authors.forename: E J
authors.initials: EJ
authors.lastname: Gallagher
mesh_terms: D000208:Acute Disease; D000328:Adult; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology
chemical_list: D003907:Dexamethasone