- Patients with migraine treated with long-acting methylprednisolone acetate (e.g., Depo-Medrol; Pfizer) do not experience more headache-free days following discharge than those who receive dexamethasone.
- These patients should receive anticipatory guidance.
Why this matters
- Most patients treated in the emergency department (ED) for migraine redevelop headache within 48 hours of discharge.
- Dexamethasone is efficacious when combined with migraine-abortive medication.
- A depot steroid like methylprednisolone acetate, which remains active for 14 days, might theoretically offer longer-lasting relief.
- This drug has not previously been investigated for migraine, to the authors’ knowledge.
- Methylprednisolone vs dexamethasone:
- Headache days: 3.3 vs 3.0 (95% CI for difference, −0.4 to 1.1);
- Freedom from headache for entire week: 5% (6/110) vs 9% (10/107) (95% CI for difference, −3% to 11%).
- Randomized researcher-masked 2-ED clinical trial in the Bronx, NY.
- 220 adults with moderate-severe migraine received 10 mg intravenous metoclopramide (e.g., Reglan) plus either 10 mg intramuscular dexamethasone or 160 mg intramuscular methylprednisolone.
- Outcome: headache days in the week after ED discharge.
- Funding: Montefiore Emergency Department; Harold and Muriel Block Institute for Clinical and Translational Research at Einstein and Montefiore.
- Impossible to mask patients to study-drug assignment.