Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence.

Abstract

OBJECTIVE:

To examine the effectiveness of parenteral corticosteroids for the relief of acute severe migraine headache and prevention of recurrent headaches.

DESIGN:

Meta-analysis.

DATA SOURCES:

Electronic databases (Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, and CINAHL), conference proceedings, clinical practice guidelines, contacts with industry, and correspondence with authors.

SELECTION CRITERIA:

Randomised controlled trials in which corticosteroids (alone or combined with standard abortive therapy) were compared with placebo or any other standard treatment for acute migraine in adults.

REVIEW METHODS:

Two reviewers independently assessed relevance, inclusion, and study quality. Weighted mean differences and relative risks were calculated and are reported with 95% confidence intervals.

RESULTS:

From 666 potentially relevant abstracts, seven studies met the inclusion criteria. All included trials used standard abortive therapy and subsequently compared single dose parenteral dexamethasone with placebo, examining pain relief and recurrence of headache within 72 hours. Dexamethasone and placebo provided similar acute pain reduction (weighted mean difference 0.37, 95% confidence interval -0.20 to 0.94). Dexamethasone was, however, more effective than placebo in reducing recurrence rates (relative risk 0.74, 95% confidence interval 0.60 to 0.90). Side effect profiles between dexamethasone and placebo groups were similar.

CONCLUSION:

When added to standard abortive therapy for migraine headache, single dose parenteral dexamethasone is associated with a 26% relative reduction in headache recurrence (number needed to treat=9) within 72 hours.

• Authors: Ian Colman, Benjamin W Friedman, Michael D Brown, Grant D Innes, Eric Grafstein, Ted E Roberts, Brian H Rowe
• Journal: BMJ (Clinical research ed.) (BMJ) Vol. 336 Issue 7657 Pg. 1359-61 (Jun 14 2008) ISSN: 1756-1833 [Electronic] England
• PMID: 18541610 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Anti-Inflammatory Agents
• Glucocorticoids
• Dexamethasone

Topics

• Acute Disease
• Anti-Inflammatory Agents (administration & dosage)
• Dexamethasone (administration & dosage)
• Glucocorticoids (administration & dosage)
• Humans
• Infusions, Parenteral
• Migraine Disorders (prevention & control)
• Randomized Controlled Trials as Topic
• Secondary Prevention