Steroids for migraine headaches: a randomized double-blind, two-armed, placebo-controlled trial.
BACKGROUND
Recurrence of migraine headache after treatment in the emergency department (ED) is common. Conflicting evidence exists regarding the utility of steroids in preventing migraine headache recurrence at 24-48 h.


OBJECTIVE
To determine if steroids decrease the headache recurrence in patients treated for migraine headaches in the ED.


METHODS
Double-blind placebo-controlled, two-tailed randomized trial. Patients aged >17 years with a moderately severe migraine headache diagnosed by treating Emergency Physician were approached for participation. Enrollees received either dexamethasone (10 mg i.v.) if intravenous access was utilized or prednisone (40 mg by mouth × 2 days) if no intravenous access was obtained. Each medication was matched with an identical-appearing placebo. Patients were contacted 24-72 h after the ED visit to assess headache recurrence.


RESULTS
A total of 181 patients were enrolled. Eight were lost to follow-up, 6 in the dexamethasone group and 2 in the prednisone arm. Participants had a mean age of 37 years (±10 years), with 86% female. Eighty-six percent met the International Headache Society Criteria for migraine headache. Of the 173 patients with completed follow-up, 20/91 (22%) (95% confidence interval [CI] 13.5-30.5) in the steroid arm and 26/82 (32%) (95% CI 21.9-42.1) in the placebo arm had recurrent headaches (p = 0.21).


CONCLUSIONS
We did not find a statistically significant decrease in headache recurrence in patients treated with steroids for migraine headaches.
Fiesseler
Frederick W
FW
Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey 07962-1965, USA.
Shih
Richard
R
Szucs
Paul
P
Silverman
Michael E
ME
Eskin
Barnet
B
Clement
Martin
M
Saxena
Rachna
R
Allegra
John
J
Riggs
Renee L
RL
Majlesi
Nima
N
D000328:Adult; D016009:Chi-Square Distribution; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D011241:Prednisone / Q000627:therapeutic use*; D055502:Secondary Prevention; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D005938:Glucocorticoids; D003907:Dexamethasone; D011241:Prednisone