What steroids are used for migraine treatment?

Steroids for Migraine Treatment

Systemic steroids are primarily used for status migrainosus (a severe, continuous migraine that may last up to one week) but are not recommended for routine acute migraine attacks due to limited evidence of efficacy. 1

Primary Role of Steroids in Migraine Management

• Steroids are not first-line treatments for routine migraine attacks but serve specific purposes in migraine care 1
• Corticosteroids are most beneficial for:
  • Status migrainosus (prolonged, severe migraine lasting up to a week) 1, 2
  • Preventing headache recurrence after emergency treatment 3, 4
  • Managing refractory headaches that don't respond to standard treatments 3
  • Assisting during medication withdrawal in patients with medication-overuse headache 2

Specific Steroids Used in Migraine Treatment

• Oral corticosteroids:

  • Prednisone - used in short, rapidly tapering courses for status migrainosus 2
  • Dexamethasone - used in short courses for status migrainosus and to prevent headache recurrence 2, 4

• Intravenous corticosteroids:

  • Methylprednisolone - used for breaking long-lasting migraine attacks, either as single dose in emergency settings or multiple doses in hospital settings 2
  • Dexamethasone - used to reduce headache recurrence after emergency department discharge 4

Administration and Dosing Considerations

• Steroids can be administered via different routes:

  • Oral administration with short-tapering schedules 3, 2
  • Intravenous administration for severe, refractory cases 2, 4
  • Single-dose or short-course regimens depending on clinical scenario 3

• Safety considerations:

  • Corticosteroids should be limited to no more than six administrations annually to minimize adverse effects 3
  • Not recommended for routine use in typical migraine attacks 1

Standard Treatment Algorithm for Migraine (Context for Steroid Use)

1. First-line treatments for mild to moderate migraine:

   • NSAIDs (aspirin, ibuprofen, naproxen sodium) 1
   • Combination analgesics containing caffeine 1

2. First-line treatments for moderate to severe migraine:

   • Triptans (sumatriptan, rizatriptan, zolmitriptan, naratriptan) 1
   • Dihydroergotamine (DHE) 1

3. When to consider steroids:

   • For status migrainosus not responding to standard treatments 1, 2
   • To prevent recurrence after emergency treatment 3, 4
   • For patients with severe disability from refractory headaches 3

Important Cautions and Limitations

• There are no good studies documenting steroid efficacy in routine acute migraine attacks 1
• Steroids should not be used as regular abortive therapy for episodic migraine due to potential side effects with prolonged use 2
• Steroids are not recommended as migraine preventive therapy 5, 2
• When other options fail, steroids may be considered as part of rescue therapy, particularly for preventing headache recurrence 3, 4