From the Guidelines
Steroids, such as prednisone, are not recommended as a first-line treatment for migraine abortive therapy, but may be considered as a second-line or rescue therapy for severe, prolonged migraines or status migrainosus. According to the study published in the American Family Physician in 2002 1, steroid therapy may be the treatment of choice for patients with status migrainosus, but there are no good studies documenting its efficacy in the treatment of the acute migraine attack. The study suggests that steroids may be used as an adjunctive therapy to treat the associated symptoms of migraine and provide synergistic analgesia.
Some key points to consider when using steroids for migraine abortive therapy include:
- They should be used sparingly due to potential side effects
- They are most effective when combined with standard abortive medications rather than used alone
- They should be considered when patients have failed to respond to triptans, NSAIDs, or other first-line treatments
- The most common regimen is oral prednisone at 60-100mg as a single dose or dexamethasone 10-25mg, which can be given orally or parenterally
It's also important to note that steroids are contraindicated in patients with certain conditions like uncontrolled diabetes, active infections, or peptic ulcer disease. As stated in the study 1, the evidence is insufficient to establish a defined role for steroid therapy in the treatment of acute migraine attacks, and therefore, they should be used with caution and under the guidance of a healthcare professional.
From the Research
Role of Steroids in Migraine Abortive Therapy
- Steroids, such as prednisone, are used in the abortive therapy of status migrainosus, although this practice is based more on clinical experience than on published data 2.
- A study using intravenous dexamethasone found that patients with episodic migraines responded more favorably than those with intractable migraines, with response rates ranging from 80-89% 2.
- The addition of prochlorperazine to dexamethasone significantly shortened the response time, suggesting a potential benefit of combining steroids with other medications in migraine abortive therapy 2.
- Steroids are listed as one of the options for acute care in migraine therapy, along with analgesics, antiemetics, and selective serotonin agonists 3.
- While steroids are not typically considered a first-line treatment for migraine prophylaxis, they may be used in certain cases to help reduce the frequency or severity of attacks 4.
Comparison with Other Treatments
- The efficacy of steroids in migraine abortive therapy is not as well-studied as other treatments, such as triptans or ergots 5.
- Triptans, such as sumatriptan, have been shown to be highly effective in treating migraine attacks, with response rates similar to those seen with steroids 5.
- Preventive medications, such as beta-blockers or anti-epileptic drugs, may be more effective in reducing the frequency or severity of migraine attacks than steroids 6, 4.