Dexamethasone Has No Benefit in Acute Migraine but Might Reduce Recurrence

Inflammation might contribute to acute migraine, and, therefore, corticosteroids could be a helpful treatment. Researchers performed a meta-analysis of seven randomized, controlled studies (involving 738 patients) that compared single-dose parenteral dexamethasone (10–24 mg) with placebo for treatment of acute migraine headache in adults who also received standard abortive therapy.

No differences in acute pain relief were noted between the dexamethasone and placebo groups. However, patients in the dexamethasone group were significantly less likely than those in the placebo group to have recurrent headache within 72 hours (39.9% vs. 29.6%; relative risk, 0.74). Incidences of adverse effects (including restlessness, drowsiness, tingling, numbness, and swelling) were similar between groups. The dexamethasone group was more likely to report dizziness than was the placebo group (RR, 2.15) and less likely to have nausea (RR, 0.70) or other adverse events (RR, 0.50). The authors conclude that when added to standard acute migraine treatment, a single parenteral dose of dexamethasone is associated with a 26% reduction in headache recurrence within 72 hours. An accompanying editorial notes that patients with diabetes should be treated with caution because of the potential for prolonged elevation of blood sugar.