steroids in migraine

 Q: 43 years old female is admitted to ICU with a severe headache. Diagnostic workup was essentially negative and the patient was diagnosed as status migrainosus in view of her previous history. Intravenous dexamethasone may be useful in resolving the acute attack? 

 A) True 

 B) False 

 Answer: B 

Status migrainosus is defined as a severe intractable migraine attack lasting for more than 72 hours. Standard treatment includes intravenous fluids (IVF), IV ketorolac, a dopamine receptor blocker. valproate, NSAID, and dihydroergotamine. Dexamethasone has no role in the relief of an acute attack or status migrainosus. But it is very effective in preventing relapse from 24 to 72 hours after treatment.

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References:

1. Colman I, Friedman BW, Brown MD, et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008; 336:1359. 2. 

2. Singh A, Alter HJ, Zaia B. Does the addition of dexamethasone to standard therapy for acute migraine headache decrease the incidence of recurrent headache for patients treated in the emergency department? A meta-analysis and systematic review of the literature. Acad Emerg Med 2008; 15:1223. 

3. Rozen TD. Emergency Department and Inpatient Management of Status Migrainosus and Intractable Headache. Continuum (Minneap Minn) 2015; 21:1004. 

4. Iljazi A, Chua A, Rich-Fiondella R, et al. Unrecognized challenges of treating status migrainosus: An observational study. Cephalalgia 2020; 40:818.