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Randomized Controlled Trial of Intravenous
Dexamethasone to Prevent Relapse
in Acute Migraine Headache
Rowe BH, Colman I, et al.
Posted: June 2008  
Headache  2008;48:333-340

Objectives:   Migraine headache is a common presentation in the emergency department (ED). Inflammation is thought to play a role in the pathophysiology of migraine and there is conflicting evidence regarding the effect of corticosteroids on reducing early recurrences. We conducted a randomized clinical trial to test the hypothesis that dexamethasone (DEX) reduced headaches after discharge and examine the factors associated with relapse.

Methods:   Consenting adults (18 and older) presenting with acute migraine at 4 EDs were enrolled. In addition to standard IV abortive therapy, using concealed allocation patients were randomized to receive IV DEX or placebo (PLA) in a double-blind fashion. Relapse was defined as a return to the ED, an urgent clinic visit, or a headache that precluded normal activity reported during follow-up telephone interviews 48-72 hours and 7 days after ED discharge. Intention to treat was used for all final analyses.

Results:   A total of 130 patients were randomized; 126 patients are included in the analysis; 64 received DEX and 62 received PLA. Mean age was 35 years; 81% was female; most suffered from headaches at least monthly. At 48-72 hours, relapses occurred in 22% in the DEX group and 32% in the PLA groups.

Conclusions:   The overall relapse rate differed from those previously reported; however, DEX failed to reduce headache relapses after ED discharge. Relapse was closely associated with incomplete pain relief at discharge. Further research is needed to determine the factors associated with migraine relapse.