Abstract | BACKGROUND: 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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Authors | B W Friedman, P Greenwald, T C Bania, D Esses, M Hochberg, C Solorzano, J Corbo, J Chu, E Chew, P Cheung, S Fearon, J Paternoster, A Baccellieri, S Clark, P E Bijur, R B Lipton, E J Gallagher |
Journal | Neurology
(Neurology)
Vol. 69
Issue 22
Pg. 2038-44
(Nov 27 2007)
ISSN: 1526-632X [Electronic] United States |
PMID | 17942818
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
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Chemical References |
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Topics |
- Acute Disease
- Adult
- Dexamethasone
(administration & dosage)
- Double-Blind Method
- Emergency Medical Services
(methods)
- Emergency Service, Hospital
- Female
- Humans
- Injections, Intravenous
- Male
- Middle Aged
- Migraine Disorders
(drug therapy, epidemiology, pathology)
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