Klapper and Stanton compared dexamethasone 6 mg IV plus metoclopramide 5-10 mg IV with DHE 0.75-1 mg IV plus metoclopramide 5-10 mg IV and to placebo/NS IV; both DHE/metoclopramide (82%) and dexamethasone/metoclopramide (78%) provided a greater percentage of patients with headache relief at 30 minutes than placebo (20%, P < .002) but were not significantly different

from one.28 Baden and Hunter compared dexamethasone 10 mg IV with placebo/NS IV as adjuvant treatment to prevent recurrence 48-72 hours post-ED discharge; headache recurrence was lower with dexamethasone (12.9% vs 58.3%, P < .001), and there was an equal incidence of side effects (19.4% vs 20.8%, P = 1.0), none serious.29 Friedman et al compared dexamethasone 10 mg IV U0126 in vivo with placebo/NS IV for prevention of headache recurrence within AP24534 solubility dmso 24 hours.30 Both groups received metoclopramide 20 mg plus diphenhydramine 25 mg IV (which could be repeated twice) for

initial treatment. The percentage headache free at discharge who remained so at 24 hours was similar (dexamethasone 25% vs placebo 19%, P = .34). When the subgroup of patients whose headache duration was more than 72 hours at ED presentation was analyzed separately, the difference in sustained pain freedom almost met the criterion for statistical significance (dexamethasone 38% vs placebo 13%, P = −.06). In the dexamethasone group, 6% reported a “burning sensation” at the injection site. Rowe et al compared dexamethasone 15 mg IV with placebo/NS IV of in preventing migraine recurrence 48-72 hours and 7 days post-discharge.31 The percentage reporting severe headache recurrence was similar for both dexamethasone and placebo at 48-72 hours (22%

vs 32%) and at 7 days (28% vs 40%). Of note, headache recurrence was more likely to occur if the pain rating on the VAS at discharge was >20 mm (P < .05). Innes et al compared dexamethasone 24 mg IV with placebo/NS IV in preventing recurrence of severe headache.27 Although the percentage with severe headache at 48 hours was greater for placebo (18% vs 45%, P = .005), there was no difference in the frequency of experiencing any degree of headache recurrence (65% vs 67%). Thirty-seven adverse events were reported for dexamethasone and 47 for placebo, the most common being drowsiness (34%), restlessness (24%), and nausea (21%). Donaldson et al compared dexamethasone 24 mg IV with placebo/NS IV, and the rate of headache recurrence was similar in the 2 groups at both the 3-day (dexamethasone 35% vs placebo 45%, P = .38) and 30-day follow-up (43% vs 47%, P = .68).32 Feisseler et al compared either dexamethasone 10 mg IV or prednisone 40 mg PO daily ×2 days vs placebo (either NS IV or lactulose PO).33 Only patients with IV access were given IV steroid or placebo. Headache recurrence at 24-72 hours of follow-up was not significantly different for steroid vs placebo (22% vs 32%, respectively; P = .21).