Kelly A-M, Kerr D, Clooney M
Joseph Epstein Centre for Emergency Medicine Research at Western Health and The University of Melbourne, Melbourne, Australia.
Emerg Med J. 2008 Jan;25(1):26-9. doi: 10.1136/emj.2007.052068.
Evidence suggests that the rate of recurrent headache after treatment of migraine in the emergency department (ED) is high. The mechanisms for this are unclear, but neurogenic inflammation may play a role. There is conflicting evidence about whether adjuvant dexamethasone reduces the rate of recurrent headache. The aim of this study was to compare the rate of recurrent headache in patients with migraine randomised to receive a single dose of oral dexamethasone or placebo at discharge after treatment in the ED with intravenous phenothiazine.
A double-blind, randomised, placebo-controlled trial was conducted in the ED of three community teaching hospitals. Adult patients with physician-diagnosed migraine were treated with intravenous phenothiazine and at discharge were randomised to receive either 8 mg oral dexamethasone or placebo as a single dose. Follow-up was by telephone at 48-72 h and the proportion of patients with recurrent headache overall and in the subgroup with headache duration <24 h was recorded.
63 patients (76% women) of median age 39 years were enrolled, 61 of whom (97%) completed follow-up. The pooled rate of recurrent headache was 33%. 32 were randomised to placebo and 31 to dexamethasone. The rate of recurrent headache in the dexamethasone and control groups was 27% (8/30) vs 39% (12/31) (relative risk (RR) 0.69, 95% CI 0.33 to 1.45, p = 0.47). For 40 patients with headache lasting <24 h the rate of recurrent headache in the dexamethasone and control groups was 15% (3/20) vs 45% (9/20), a reduction in absolute risk of 30% (RR 0.33, 95% CI 0.11 to 1.05, p = 0.08).
A single oral dose of dexamethasone following phenothiazine treatment for migraine in the ED did not reduce the rate of recurrent headache. There is weak evidence for a possible benefit in the subgroup who present within <24 h of symptom onset. A multicentre trial to confirm this finding is warranted.
有证据表明，急诊科（ED）偏头痛治疗后复发性头痛的发生率很高。其机制尚不清楚，但神经源性炎症可能起作用。关于辅助使用地塞米松是否能降低复发性头痛的发生率，证据存在冲突。本研究的目的是比较在ED接受静脉注射吩噻嗪治疗后出院时随机接受单剂量口服地塞米松或安慰剂的偏头痛患者的复发性头痛发生率。
在三家社区教学医院的急诊科进行了一项双盲、随机、安慰剂对照试验。经医生诊断为偏头痛的成年患者接受静脉注射吩噻嗪治疗，出院时随机接受8毫克口服地塞米松或安慰剂单剂量治疗。在48 - 72小时通过电话进行随访，并记录总体复发性头痛患者以及头痛持续时间<24小时亚组中的患者比例。
纳入了63例患者（76%为女性），中位年龄39岁，其中61例（97%）完成了随访。复发性头痛的合并发生率为33%。32例被随机分配到安慰剂组，31例被随机分配到地塞米松组。地塞米松组和对照组的复发性头痛发生率分别为27%（8/30）和39%（12/31）（相对风险（RR）0.69，95%置信区间0.33至1.45，p = 0.47）。对于40例头痛持续时间<24小时的患者，地塞米松组和对照组的复发性头痛发生率分别为15%（3/20）和45%（9/20），绝对风险降低了30%（RR 0.33，95%置信区间0.11至1.05，p = 0.08）。
在ED对偏头痛进行吩噻嗪治疗后单次口服地塞米松并不能降低复发性头痛的发生率。对于症状发作<24小时内就诊的亚组，有微弱证据表明可能有益。有必要进行一项多中心试验来证实这一发现。
