Emergency Med Medical News about dexamethasone; short-term relapse; acute migraine

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Review: adding dexamethasone to standard therapy reduces short-term relapse for acute migraine in the emergency department
Evidence-Based Medicine, 08/10/09

Carpenter CR – In patients presenting to the emergency department with acute migraine headache, adding dexamethasone to standard therapy reduces short–term relapse.

Methods

Randomised controlled trials (RCTs) in which patients and treating physicians were blinded were retrieved from Medline (1950–May 2008); EMBASE/Excerpta Medica, CINAHL, LILACS, and Cochrane Central Register of Controlled Trials {all to May 2008}*; ClinicalTrials.gov; reference lists; and abstracts from major emergency medicine conferences published in the past 7 years.
Authors were contacted for additional information.
7 trials (n = 742), including 2 reported only as abstracts, met the selection criteria: 3 used a 5–point headache severity scale, 3 used a 4–point scale, and 1 used a dichotomous outcome.
5 trials gave dexamethasone (8–24 mg) as a single intravenous injection, 1 gave the drug (20 mg) intravenously or intramuscularly, and 1 used oral tablets (8 mg).
All studies were high quality (Jadad scale scores 5 out of 5).

Results

Meta–analysis showed that adding dexamethasone to standard therapy for migraine reduced moderate–to–severe headaches at 24–72 hours.
Adverse events occurred in 26% of patients in the dexamethasone group and 23% in the placebo group but were not clearly reported in all trials.

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