From the Research
The recommended corticosteroid dose for migraine treatment is typically 4-10 mg of dexamethasone given as a single intravenous or oral dose in emergency settings, or oral prednisone at 60-80 mg daily for a short course of 3-5 days, with some regimens using a taper over 5-7 days, as supported by the most recent evidence 1.
Key Considerations
- Corticosteroids are most effective when used for short-term treatment of severe migraines, particularly for breaking cycles of status migrainosus or preventing recurrence after initial treatment 2, 3, 1.
- They work by reducing inflammation and stabilizing the blood-brain barrier, which helps decrease the neurogenic inflammation associated with migraines 4.
- Steroids should be used cautiously due to potential side effects including insomnia, increased appetite, mood changes, and elevated blood sugar, and are not recommended for frequent use due to risks of long-term steroid complications 2, 5.
Treatment Options
- Dexamethasone is commonly used for migraine treatment, typically at doses of 4-10 mg given as a single intravenous or oral dose in emergency settings 1.
- For outpatient treatment, oral prednisone is often prescribed at 60-80 mg daily for a short course of 3-5 days, with some regimens using a taper over 5-7 days 2, 4.
- Methylprednisolone dose packs (starting at 24 mg and tapering over 6 days) are another option 4.
Important Notes
- Steroids are typically reserved for patients who haven't responded to first-line treatments like triptans, NSAIDs, or antiemetics 5.
- The use of corticosteroids in migraine treatment should be guided by the most recent evidence and individual patient needs, with careful consideration of potential benefits and risks 1.