What are the drawbacks of using a Medrol (methylprednisolone) dose pack to treat migraine headaches when nonsteroidal anti-inflammatory drugs (NSAIDs) are ineffective?

From the Guidelines

Methylprednisolone (Medrol) dose packs should not be the first choice for stopping migraine headaches while traveling when NSAIDs aren't working, and instead, triptans or other alternatives should be considered. According to the American College of Physicians guideline 1, if patients use an adequate dose of an NSAID or acetaminophen and still do not have sufficient pain relief, then adding a triptan to an NSAID, or to acetaminophen when NSAIDs are contraindicated or not tolerated, is recommended. Some key points to consider when treating migraine headaches include:

• Ensuring the appropriate dosage of NSAIDs or acetaminophen is used, and considering increasing the dosage without exceeding the recommended maximum daily dose 1
• Adding a triptan to an NSAID or acetaminophen for patients who do not achieve sufficient pain relief 1
• Considering the use of CGRP antagonists-gepants or ergot alkaloid for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1 The downside of using methylprednisolone (Medrol) dose packs includes potential side effects such as insomnia, increased appetite, mood changes, elevated blood sugar, fluid retention, and increased risk of infection, as well as more serious issues like osteoporosis, adrenal suppression, and weight gain with long-term or frequent use. It's essential to consult with a doctor before using steroids for migraines, especially if you have conditions like diabetes, high blood pressure, or a history of stomach ulcers, and to consider alternative treatments that are specifically designed for migraines, such as triptans or anti-nausea medications with pain-relieving properties.

From the FDA Drug Label

The lowest possible dose of corticosteroid should be used to control the condition under treatment, and when reduction in dosage is possible, the reduction should be gradual. Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression to frank psychotic manifestations Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.

The downside of using a methylprednisolone dose pack to stop a migraine headache while traveling when NSAIDs are not working includes:

• Psychic derangements such as euphoria, insomnia, mood swings, personality changes, and severe depression
• Aggravation of existing emotional instability or psychotic tendencies
• Other potential risks associated with corticosteroid use, such as increased risk of scleroderma renal crisis, peptic ulcer, osteoporosis, and myasthenia gravis 2 The use of methylprednisolone to treat migraine headaches is not explicitly mentioned in the drug label, and therefore, no conclusion can be drawn about its effectiveness for this purpose.

From the Research

Metro Dose Pack for Migraine Headache

• A metro dose pack, also known as a methylprednisolone dose pack, is a type of corticosteroid medication that can be used to treat migraine headaches 3.
• Corticosteroids, such as methylprednisolone, are commonly used as therapy for status migraine, which is a severe and prolonged migraine attack 3, 4.
• The use of corticosteroids, such as methylprednisolone, can help to alleviate status migraine by reducing inflammation and swelling in the blood vessels 3.

Effectiveness of Metro Dose Pack

• The effectiveness of a metro dose pack for migraine headache is supported by several studies, which have shown that corticosteroids can be effective in reducing the frequency and severity of migraine attacks 3, 4, 5.
• A study published in the Journal of the American Medical Association (JAMA) found that corticosteroids, such as methylprednisolone, were associated with improved pain and function in patients with migraine 5.
• Another study published in the journal Neurology found that triptans, ergots, and antiemetics were the most effective classes of medications for acute migraine treatment, but also noted that corticosteroids can be effective in certain cases 6.

Downside of Metro Dose Pack

• The downside of using a metro dose pack for migraine headache is the potential for side effects, such as weight gain, mood changes, and increased blood sugar levels 3, 4.
• Long-term use of corticosteroids, such as methylprednisolone, can also lead to more serious side effects, such as osteoporosis, cataracts, and glaucoma 3, 4.
• Additionally, the use of corticosteroids, such as methylprednisolone, can lead to rebound headaches, which can occur when the medication is stopped or the dose is reduced 3, 4.