Dexamethasone Hastens Migraine Resolution

Purpose: If corticosteroids are an effective abortive migraine treatment in the non-pregnant adult population, corticosteroids could be trialed for acute, severe migraine treatment in pregnancy. The purpose of this evidence-based practice review was to determine the efficacy of DXM at achieving acute severe migraine resolution in non-pregnant adult migraineurs. Methods: PubMed and Academic Search Complete searches for randomized controlled trials (RCT) of steroids for migraine treatment yielded two RCT and two pooled analyses for inclusion. Results: The pooled analyses showed that at 24to 72-hour follow-up, 12– 24 mg parenteral DXM added to standard abortive migraine therapy reduces moderate or severe migraine recurrence by 29%. DXM 16 mg intravenous treats acute migraine without aura, as well as, does 400 mg intravenous sodium valproate. For migraine resolution comparable to that achieved by intravenous magnesium sulfate 1 gram, intravenous low dose DXM 8 mg may best be administered without intravenous metoclopramide 10 mg. Conclusion: Given dose-dependent efficacy of DXM for treatment of acute severe migraine, migraine resolution needs higher initial DXM doses than used for FLM. To benefit pregnant migraineurs, RCT of intramuscular DXM 12-24 mg, with or with anti-emetics such as dimenhydrinate, doxylamine/ pyridoxine, ondansetron, or promethazine, in comparison to 1-2 mg intravenous magnesium sulfate are needed.