Greater doses of intravenous (IV) dexamethasone when added to metoclopramide doesn’t enhance outcomes in sufferers experiencing acute migraine headache within the emergency division, in response to examine findings revealed in Neurology.
Researchers within the Bronx, New York performed a randomized, double-blind, managed trial, Dexamethasone for Migraine – Dose Comparability, (ClinicalTrials.gov Identifier: NCT04112823) at Montefiore/Einstein Medical Middle from December 2019 till August 2022 with a pause between March and June of 2020 attributable to COVID-19 pandemic restrictions.
Of the 1823 sufferers screened, 209 (common age, 38; 86% ladies) have been randomly assigned to 2 intervention teams —104 who obtained 10 mg of metoclopramide plus 4 mg of dexamethasone through IV drip over a 15-minute interval and 105 who obtained 10 mg of metoclopramide plus 16 mg of dexamethasone through IV drip.
Previous to receiving therapy within the emergency division, 151 of the 209 (72%) people skilled migraine of extreme depth and the remaining 28% skilled migraine of reasonable depth.
When added to 10mg IV metoclopramide, doses of dexamethasone larger than 4mg are unlikely to learn sufferers within the ED with migraine.
Whereas within the emergency division, 77 of the 104 (74%) people within the low-dose dexamethasone group and 82 of the 105 (78%) people within the high-dose dexamethasone group attained headache aid inside 2 hours of therapy administration (absolute distinction, 4%; 95% CI, -8% to 16%).
The researchers obtained 48-hour and 7-day follow-up knowledge through phone name relating to headache aid and variety of complications throughout the week following discharge. A complete of 5 sufferers have been misplaced to follow-up.
Sustained headache aid after discharge occurred in 35 of 102 (34%) sufferers within the low-dose dexamethasone group and 42 of 102 (41%) sufferers within the high-dose dexamethasone group (absolute distinction, 7%; 95% CI, -6% to twenty%).
Inside 7 days of discharge from the emergency division, contributors who obtained low-dose dexamethasone reported a median of two headache days. Equally, contributors within the high-dose dexamethasone group reported a median of two headache days the week after discharge (imply distinction, 0.4; 95% CI, -0.3 to 1.2)
“When added to 10 mg IV metoclopramide, doses of dexamethasone larger than 4 mg are unlikely to learn sufferers within the ED with migraine,” the researchers wrote. Research limitations included lack of generalizability to populations in settings apart from the two educational emergency departments within the Bronx or individuals who obtain different therapies for acute migraine assaults, together with oral corticosteroids. The examine ended early, which can have affected the true magnitude of absolute variations. Moreover, the researchers didn’t account for the way different medical comorbidities affected the dose and efficacy of migraine therapies.