Steroids for Migraine Headaches: A Randomized Double-Blind, Two-Armed, Placebo-Controlled Trial

Fiesseler, Frederick W.; Shih, Richard; Szucs, Paul; Silverman, Michael E.; Eskin, Barnet; Clement, Martin; Saxena, Rachna; Allegra, John; Riggs, Renee L.; Majlesi, Nima

doi:10.1016/j.jemermed.2009.08.022

« Previous Next »The Journal of Emergency Medicine
Volume 40, Issue 4 , Pages 463-468, April 2011

Steroids for Migraine Headaches: A Randomized Double-Blind, Two-Armed, Placebo-Controlled Trial

This work was previously presented at the American Academy of Emergency Medicine, Las Vegas, NV, 2007.

Frederick W. Fiesseler, DO
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey
- Reprint Address: Frederick W. Fiesseler, do, Department of Emergency Medicine (Box 8), Morristown Memorial Hospital, 100 Madison Avenue, Morristown, NJ 07962-1965
Richard Shih, MD
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey
Paul Szucs, MD
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey
Michael E. Silverman, MD
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey
Barnet Eskin, MD, PHD
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey
Martin Clement, MD
- Department of Emergency Medicine, St. Clare's Hospital, Denville, New Jersey
Rachna Saxena, DO
- Department of Emergency Medicine, Englewood Hospital, Englewood, New Jersey
John Allegra, MD, PHD
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey
Renee L. Riggs, DO
- Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School at New Brunswick, New Brunswick, New Jersey
Nima Majlesi, DO
- Department of Emergency Medicine, Morristown Memorial Hospital, Morristown, New Jersey

Received 17 January 2009; received in revised form 14 May 2009; accepted 29 August 2009. published online 22 October 2009.

Abstract

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). Conclusion: We did not find a statistically significant decrease in headache recurrence in patients treated with steroids for migraine headaches.

Keywords: headache, emergency medicine, migraine, steroids, dexamethasone, prednisone