Dexamethasone Dose for Migraine Treatment in the Emergency Department

After initial treatment of acute migraine within the emergency department, approximately 66% of patients experience post-discharge headache, while a notable 50% have headache for more than 2 days in the week after discharge. The American Headache Society recommends dexamethasone to reduce post-discharge headache recurrence, although the optimal dose remains uncertain. This randomized, double-blind study involving 209 patients investigated the efficacy of low-dose (4 mg) and high-dose (16 mg) dexamethasone when administered alongside 10 mg of intravenous metoclopramide. The primary outcome was headache relief at 48 hours; relief at 2 hours and 7 days was also assessed.

Sustained headache relief, defined as residual headache intensity of “none…