Randomized controlled trial of intravenous dexamethasone to prevent relapse in acute migraine headache

摘要: Objectives.— Migraine headache is a common presentation in the emergency department (ED). Inflammation thought to play role pathophysiology of migraine and there conflicting evidence regarding effect corticosteroids on reducing early recurrences. We conducted randomized clinical trial test hypothesis that dexamethasone (DEX) reduced headaches after discharge examine factors associated with relapse. Methods.— Consenting adults (18 older) presenting acute at 4 EDs were enrolled. In addition standard intravenous (IV) abortive therapy, using concealed allocation patients receive IV DEX (15 mg) or placebo (PLA) double-blind fashion. Relapse was defined as return ED, an urgent clinic visit, precluded normal activity reported during follow-up telephone interviews 48-72 hours 7 days ED discharge. Intention treat used for all final analyses. Results.— A total 130 randomized; 126 are included analysis (one patient left prior treatment 3 enrolled twice); 64 received 62 PLA. Mean age 35 years, 81% female; most (77%) suffered from least monthly. On 10-point visual analog scale (VAS), median pain scores 8 presentation, 2 At hours, relapses occurred 14/64 (22%) group 20/62 (32%) PLA groups (OR = 0.6; 95% CI: 0.3-1.3). By day 7, 18/64 (28%) had relapsed, compared 25/62 (40%) Controlling assignment, relapse more when incompletely relieved (VAS > 2) (OR = 2.2; 1.1-5.4). Conclusions.— The overall rate differed those previously reported; however, failed reduce closely incomplete relief Further research needed determine relapse.