Parenteral Corticosteroids as Adjuvant Therapy for Migraine Headaches

Parenteral Corticosteroids as Adjuvant Therapy for Migraine Headaches:

A. Overview/Aims: Five million Americans present to emergency departments (ED) annually with headaches [1]. The majority of these patients have migraine headaches [2,3]. Parenteral medications of proven benefit for acute migraines include the triptans [4], dopamine-receptor antagonists [5-11], non-steroidals [12], and dihydroergotamine [13]. Although these distinct classes of medication are often effective for the treatment of acute migraines, their use is complicated by treatment failures [4,9,14], recurrence of headache [15,16], and side effects [17], all of which are of concern for patients with migraines [18]. The ideal medication, which would rapidly alleviate migraine pain without any recurrence of pain or side effects, has not yet been identified.

The role of corticosteroids in acute migraines is ill-defined. Although used in patients with intractable migraines, this class of medication is not widely used in typical migraine attacks. However, limited clinical data suggest that corticosteroids decrease the rate of recurrent headaches [19-21] and might decrease the pain of an acute attack [22]. Further research is needed to define the role of corticosteroids in the ED treatment of acute migraine headaches.

Specific Aim: The specific aim of this study is to determine the efficacy of ten milligrams of parenteral dexamethasone as adjuvant therapy for the emergency department treatment of migraine headaches.

Primary Hypothesis: Twenty four hours after medication administration, a greater percentage of migraine subjects who received dexamethasone will have: