Corticosteroids: Ever an Option for Patients With Migraine?

What are the current recommendations for the use of corticosteroids in the treatment of migraine? Is this a therapy primary care clinicians might consider?

- Julie Neely, MD
   Blacksburg, Va

When a patient experiences a prolonged migraine attack (longer than 24 hours) that does not respond to abortive medications, such as the triptans, the cause is probably sterile inflammation around the affected blood vessels. This type of headache was initially described by Wolff in 1948.¹

In prolonged migrainous episodes, further treatment with triptans is of no avail and narcotic agents provide only minimal relief. In our clinic, such episodes are usually treated-often successfully--with methylprednisolone, 80 mg IM, or oral dexamethasone or methylprednisolone, 75 mg (12 tablets over 5 days as follows: 2 tablets bid for 2 days, 1 tablet bid for 1 day, then 1 tablet daily for 2 days). However, we restrict this treatment to no more than once monthly.

Corticosteroid treatment is an option that primary care clinicians should consider for their patients with prolonged migraine.

- Seymour Diamond, MD
   Director, Diamond Headache Clinic
   Adjunct Professor of Cellular and Molecular
    Pharmacology
   Clinical Professor of Family Medicine
   Finch University of Health Sciences/
    The Chicago Medical School

References:

REFERENCE:

1.

Wolff HG.

Headache and Other Head Pain.

New York: Oxford University Press; 1948.