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Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomised controlled trial

Kelly, A-M, Kerr, D and Clooney, M 2008, Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomised controlled trial, Emergency medicine journal, vol. 25, no. 1, pp. 26-29, doi: 10.1136/emj.2007.052068.

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Title Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomised controlled trial
Author(s) Kelly, A-M
Kerr, DORCID iD for Kerr, D orcid.org/0000-0002-2956-2432
Clooney, M
Journal name Emergency medicine journal
Volume number 25
Issue number 1
Start page 26
End page 29
Total pages 4
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2008
ISSN 1472-0205
1472-0213
Summary OBJECTIVE: Evidence suggests that the rate of recurrent headache after treatment of migraine in the emergency department (ED) is high. The mechanisms for this are unclear, but neurogenic inflammation may play a role. There is conflicting evidence about whether adjuvant dexamethasone reduces the rate of recurrent headache. The aim of this study was to compare the rate of recurrent headache in patients with migraine randomised to receive a single dose of oral dexamethasone or placebo at discharge after treatment in the ED with intravenous phenothiazine.

METHODS: A double-blind, randomised, placebo-controlled trial was conducted in the ED of three community teaching hospitals. Adult patients with physician-diagnosed migraine were treated with intravenous phenothiazine and at discharge were randomised to receive either 8 mg oral dexamethasone or placebo as a single dose. Follow-up was by telephone at 48-72 h and the proportion of patients with recurrent headache overall and in the subgroup with headache duration <24 h was recorded.

RESULTS: 63 patients (76% women) of median age 39 years were enrolled, 61 of whom (97%) completed follow-up. The pooled rate of recurrent headache was 33%. 32 were randomised to placebo and 31 to dexamethasone. The rate of recurrent headache in the dexamethasone and control groups was 27% (8/30) vs 39% (12/31) (relative risk (RR) 0.69, 95% CI 0.33 to 1.45, p = 0.47). For 40 patients with headache lasting <24 h the rate of recurrent headache in the dexamethasone and control groups was 15% (3/20) vs 45% (9/20), a reduction in absolute risk of 30% (RR 0.33, 95% CI 0.11 to 1.05, p = 0.08).

CONCLUSION: A single oral dose of dexamethasone following phenothiazine treatment for migraine in the ED did not reduce the rate of recurrent headache. There is weak evidence for a possible benefit in the subgroup who present within <24 h of symptom onset. A multicentre trial to confirm this finding is warranted.
Language eng
DOI 10.1136/emj.2007.052068
Field of Research 110399 Clinical Sciences not elsewhere classified
1103 Clinical Sciences
1110 Nursing
1117 Public Health And Health Services
Socio Economic Objective 920210 Nursing
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2008, Royal College of Emergency Medicine & BMJ Publishing Group
Persistent URL http://hdl.handle.net/10536/DRO/DU:30089885

Document type: Journal Article
Collection: School of Nursing and Midwifery
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