Oral Dexamethasone for Treatment of Migraine
Oral Dexamethasone for Treatment of Migraine
The aim of this project is to determine if a single dose of oral dexamethasone at the time of
 discharge from the emergency department (ED) [after successful treatment] prevents rebound
 headache.

 Hypothesis: That single dose oral dexamethasone 8mg reduces the proportion of patients who
 suffer rebound headache after treatment for migraine in the ED.
Migraine headache can be a debilitating condition. A small but significant proportion of
 sufferers seek treatment in emergency departments [ED], accounting for 2-5% of ED
 visits.Available data suggests that up to 66% of these patients may experience rebound
 headache after discharge that affects their ability to function normally [eg work, social,
 etc].It appears that inflammation plays a key role in recurrences. A number of small studies
 suggest that a single dose of corticosteroids at the time of discharge might prevent rebound
 headache. To date these studies have used intravenous dexamethasone. The aim of this project
 is to determine if a single dose of oral dexamethasone at the time of discharge from the ED
 [after successful treatment] prevents rebound headache.

 Hypothesis: That single dose oral dexamethasone 8mg reduces the proportion of patients who
 suffer rebound headache after treatment for migraine in the ED.

 Aims: The primary aim is to compare the proportion of patients who experience rebound
 headache within 48 hours after ED treatment of migraine between a group treated with single
 dose oral dexamethasone 8mg and a group treated with placebo. Secondary aims are to compare
 headache severity, analgesia/ health service use, adverse events and return to normal
 functioning between the groups.

 Methods:

 Study design: Double blind, randomised placebo controlled clinical trial. Setting: Emergency
 Department, Western Hospital. Participants: Adult patients [age >17 years] with
 physician-diagnosed migraine treated in the ED.

 Inclusion criteria: Consenting adult patients [age >17 years] with physician-diagnosed
 migraine treated in the ED who are willing and able to be contacted between 48-72 hours after
 discharge for follow-up.

 Sample size: 76 patients. Note: The study was stopped early for operational reasons. 63
 patients were analysed.
Inclusion Criteria:

 -  Consenting adult patients [age >17 years] with physician-diagnosed migraine treated in
 the ED who are willing and able to be contacted between 48-72 hours after discharge
 for follow-up

 Exclusion Criteria:

 -  Failure to consent

 -  Pregnancy

 -  Allergy to study medication

 -  Findings inconsistent with migraine

 -  Patients requiring hospital admission for further investigation and treatment

 -  Patients with active peptic ulcer disease

 -  Patients with Type 1 diabetes

 -  Patients taking corticosteroids for another condition within 7 days

 -  Active systemic fungal infection

 -  Patients previously enrolled in the study