Is it usual to administer dexamethasone (Decadron) 10mg injection with sumatriptan and diphenhydramine (Benadryl) for migraine unrelieved by ibuprofen?

From the Guidelines

For migraines unrelieved by ibuprofen, the recommended treatment protocol is to use migraine-specific agents, such as triptans, as the next line of treatment, rather than immediately administering dexamethasone (Decadron) 10mg, sumatriptan, and diphenhydramine (Benadryl). According to the guidelines from the Annals of Internal Medicine 1, the first-line treatment for migraines includes nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. If the migraine does not respond to NSAIDs, the next step is to use migraine-specific agents like triptans.

Some key points to consider:

• NSAIDs are the first-line treatment for migraines 1
• Triptans are the next line of treatment for migraines that do not respond to NSAIDs 1
• Antiemitics may be used to treat nausea and vomiting associated with migraines 1
• Preventive therapy should be considered for patients who experience frequent or severe migraines 1

In terms of specific treatment protocols, the guidelines recommend:

1. Oral triptan (e.g., sumatriptan 50-100mg) at onset of migraine
2. If needed, add an NSAID (e.g., naproxen 500mg)
3. For nausea, add an antiemetic (e.g., metoclopramide 10mg) Take these medications at the first sign of a migraine. If symptoms persist or worsen after 2 hours, a second dose of triptan may be taken, but do not exceed the maximum daily dose.

For prevention, consider:

• Daily prophylactic medication (e.g., propranolol 40-160mg/day or topiramate 25-100mg/day)
• Lifestyle modifications (regular sleep, meals, exercise; stress management)
• Trigger avoidance (if identified)

This approach targets different aspects of migraine pathophysiology, with triptans constricting blood vessels and blocking pain pathways, NSAIDs reducing inflammation, and antiemetics addressing nausea while potentially enhancing absorption of other medications. Preventive measures aim to reduce the frequency and severity of attacks by modulating neuronal excitability or vascular responses.

From the Research

Administration of Dexamethasone with Sumatriptan and Diphenhydramine for Migraine

• The administration of dexamethasone (Decadron) 10mg injection with sumatriptan and diphenhydramine (Benadryl) for migraine unrelieved by ibuprofen is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, the use of corticosteroids, such as dexamethasone, is mentioned as a rescue medication for refractory migraine attacks 3, 4, 5.
• Sumatriptan is a commonly used triptan for acute migraine treatment, and its efficacy is well-established 2, 3, 4, 5, 6.
• Diphenhydramine (Benadryl) is an antiemetic that can be used to alleviate nausea and vomiting associated with migraine 3, 4, 5.
• The combination of a triptan and a NSAID, such as ibuprofen, is recommended for moderate to severe migraine attacks, and the addition of an antiemetic like diphenhydramine may be beneficial 3, 4, 5.
• However, the specific combination of dexamethasone, sumatriptan, and diphenhydramine is not explicitly mentioned in the provided studies, and its efficacy and safety would need to be evaluated on a case-by-case basis 2, 3, 4, 5, 6.