Outpatient Corticosteroid Tx Significantly Improved Pain in Status Migrainosus

Treatment with oral dexamethasone for 4 days significantly improved pain levels in the majority of outpatients with status migrainosus, a retrospective chart review presented at the 68th AAN Annual Meeting has found.

VANCOUVER, BC—Treatment with oral dexamethasone for 4 days significantly improved pain levels for a majority of outpatients with status migrainosus, according to a retrospective chart review at the 68th AAN Annual Meeting.

Corticosteroids are used as abortive therapy in patients with acute migraines; some anecdotal studies have also reported its use for status migrainosus. The majority of these cases, however, have occurred in emergency rooms or as inpatients. Additionally, there have been some smaller cases of treatment with dihydroergotamine (DHE) and intravenous (IV) dexamethasone but this review aimed to examine the effects of oral dexamethasone in an outpatient setting.

The chart review included twenty female patients between the ages of 18–70 who presented with status migrainosus to the headache center. All patients had failed baseline prophylactic medications and at least 1 abortive medication. They received oral dexamethasone 4mg twice daily for 4 days and were allowed to continue taking their current prophylactic medications but no abortive medications. Prior to starting oral dexamethasone, the average length of a headache ranged from 3 days to 3 weeks. The patients used an average of 1.6 prophylactic medications and an average of 1.8 abortive medications. 

The review showed that 80% of patients demonstrated improvements in pain levels with scores less than 2/10. Moreover, 60% of the patients reported to be pain-free. Six patients showed a clinical response by Day 1, 6 patients by Day 2, and 3 patients by Day 3. One patient required retreatment and responded by Day 8; no benefit was reported for 4 patients after 4 days of treatment.

Adverse effects were minimal with 16 patients reporting no side effects, the researchers added.

“The treatment was well tolerated with minimal side effects, is cost effective, and easy to administer,” concluded lead author Ruth Bland, FNP, from Phoenix, AZ. She added that bigger controlled studies are necessary to confirm the efficacy of oral dexamethasone administered in an outpatient setting.