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.
RCT Entities:
BACKGROUND: Recurrence of migraineheadache after treatment in the emergency department (ED) is common. Conflicting evidence exists regarding the utility of steroids in preventing migraineheadache 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 migraineheadache 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 migraineheadache. 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.
Authors: Paola Sarchielli; Franco Granella; Maria Pia Prudenzano; Luigi Alberto Pini; Vincenzo Guidetti; Giorgio Bono; Lorenzo Pinessi; Massimo Alessandri; Fabio Antonaci; Marcello Fanciullacci; Anna Ferrari; Mario Guazzelli; Giuseppe Nappi; Grazia Sances; Giorgio Sandrini; Lidia Savi; Cristina Tassorelli; Giorgio Zanchin Journal: J Headache Pain Date: 2012-05 Impact factor: 7.277