What’s the Evidence? Corticosteroids for Migraine

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September 17, 2015 by dailybolusoflr

By Casey Carr, MD

Summary: Evidence suggests that corticosteroids, specifically dexamethasone, is not an effective drug for migraine termination. However, there is evidence that suggests it may help prevent recurrence within 48 hours.
Introduction: Intravenous corticosteroids have been used in the emergency department setting as an adjunct to migraines refractory to initial treatment. The Canadian Headache Society recently published a large meta-analysis on the treatment of acute migraine. This study recommended against the use of corticosteroids in the acute setting. Another meta-analysis, done by Colman et al, found that while corticosteroids reduced the risk of recurrence in migraine patients, they were not useful as a migraine termination medication.
Study: Colman et al performed a meta-analysis evaluating the use of corticosteroids in the use of acute migraine termination (“Parental dexamethasone for acute severe migraine headache: meta-analysis of randomized controlled trials for preventing recurrence”). The literature was searched for randomized controlled trials of parental corticosteroids given to adults with reasonable criteria distinguishing headache as migraine. 666 abstracts were potentially relevant; 7 met inclusion criteria. All studies that met inclusion criteria used dexamethasone in their treatment arm. Most included studies concealed allocation, were double blinded, and reported losses to follow up. All seven studies found dexamethasone reduced recurrence when compared to placebo (NNT=9). Pooled data from the seven studies found no significant difference in headache termination between dexamethasone and placebo, however these studies had moderate heterogeneity. Weaknesses of the study include an inability to exclude confounding from other abortive therapies, the inevitable inclusion of non-migraine headaches in the included studies, and none of the studies followed patients beyond 72 hours.
References:
  1. Colman, et al. “Parental dexamethasone for acute severe migraine headache: meta-analysis of randomized controlled trials for preventing recurrence”. British Medical Journal. 2008 June;336(7657):1359-61.
  2. Orr, et al. “Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings”. Cephalgia. 2015;35(3):271-84

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