Randomized trial of IV dexamethasone for acute migraine in the emergency department

Benjamin W. Friedman, P. Greenwald, T. C. Bania, David Esses, M. Hochberg, C. Solorzano, J. Corbo, J. Chu, E. Chew, P. Cheung, S. Fearon, J. Paternoster, Angelo Baccellieri, S. Clark, Polly E. Bijur, Richard B. Lipton, E. John Gallagher

Research output: Contribution to journalArticle

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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. CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)2038-2044
Number of pages7
JournalNeurology
Volume69
Issue number22
DOIs
StatePublished - Nov 2007

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Migraine Disorders
Dexamethasone
Hospital Emergency Service
Placebos
Headache
Metoclopramide
Therapeutics
Multicenter Studies
Adrenal Cortex Hormones

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Randomized trial of IV dexamethasone for acute migraine in the emergency department. / Friedman, Benjamin W.; Greenwald, P.; Bania, T. C.; Esses, David; Hochberg, M.; Solorzano, C.; Corbo, J.; Chu, J.; Chew, E.; Cheung, P.; Fearon, S.; Paternoster, J.; Baccellieri, Angelo; Clark, S.; Bijur, Polly E.; Lipton, Richard B.; Gallagher, E. John.

In: Neurology, Vol. 69, No. 22, 11.2007, p. 2038-2044.

Research output: Contribution to journalArticle

Friedman, BW, Greenwald, P, Bania, TC, Esses, D, Hochberg, M, Solorzano, C, Corbo, J, Chu, J, Chew, E, Cheung, P, Fearon, S, Paternoster, J, Baccellieri, A, Clark, S, Bijur, PE, Lipton, RB & Gallagher, EJ 2007, 'Randomized trial of IV dexamethasone for acute migraine in the emergency department', Neurology, vol. 69, no. 22, pp. 2038-2044. https://doi.org/10.1212/01.WNL.0000281105.78936.1d
Friedman, Benjamin W. ; Greenwald, P. ; Bania, T. C. ; Esses, David ; Hochberg, M. ; Solorzano, C. ; Corbo, J. ; Chu, J. ; Chew, E. ; Cheung, P. ; Fearon, S. ; Paternoster, J. ; Baccellieri, Angelo ; Clark, S. ; Bijur, Polly E. ; Lipton, Richard B. ; Gallagher, E. John. / Randomized trial of IV dexamethasone for acute migraine in the emergency department. In: Neurology. 2007 ; Vol. 69, No. 22. pp. 2038-2044.
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AU - Greenwald, P.

AU - Bania, T. C.

AU - Esses, David

AU - Hochberg, M.

AU - Solorzano, C.

AU - Corbo, J.

AU - Chu, J.

AU - Chew, E.

AU - Cheung, P.

AU - Fearon, S.

AU - Paternoster, J.

AU - Baccellieri, Angelo

AU - Clark, S.

AU - Bijur, Polly E.

AU - Lipton, Richard B.

AU - Gallagher, E. John

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N2 - 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. CONCLUSION: 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.

AB - 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. CONCLUSION: 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.

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