Dexamethasone Dose for Migraine Treatment in the Emergency Department

6 Oct 2023 • Dexamethasone decreases the frequency of migraine recurrence after emergency department (ED) discharge. However, the optimal dose of dexamethasone is unknown. In a randomized double-blind study, researchers aimed to investigate the effectiveness of different doses of dexamethasone when coadministered with metoclopramide for the relief of migraines in the emergency department (ED).

  • They enrolled 209 adult patients with migraines of moderate to severe intensity according to the International Classification of Headache Disorders, 3rd edition criteria.
  • These patients were randomly assigned to receive either 4 mg or 16 mg of dexamethasone intravenously in addition to 10 mg of intravenous metoclopramide.
  • The primary outcome measured was sustained headache relief, and secondary outcomes included headache relief within 2 hours and the number of headache days experienced during the week following ED discharge.

The study found that there was no significant difference in sustained headache relief between the two groups, with 34% of participants in the low-dose (4 mg) group and 41% in the high-dose (16 mg) group achieving relief. Additionally, headache relief within 2 hours was similar in both groups, with 74% in the low-dose group and 78% in the high-dose group. The number of headache days during the week after ED discharge was also comparable between the two groups.

Based on these findings, the study concluded that doses of dexamethasone greater than 4 mg, when added to 10 mg IV metoclopramide, are unlikely to provide additional benefits for patients with migraines in the ED.

Source: American Academy of Neurology | Read full story

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