Singh Amandeep, Alter Harrison J, Zaia Brita
Department of Emergency Medicine, Alameda County Medical Center-Highland Hospital, Oakland, CA, USA.
Acad Emerg Med. 2008 Dec;15(12):1223-33. doi: 10.1111/j.1553-2712.2008.00283.x. Epub 2008 Oct 25.
Neurogenic inflammation is thought to play a role in the development and perpetuation of migraine headache. The emergency department (ED) administration of dexamethasone in addition to standard antimigraine therapy has been used to decrease the incidence of recurrent headaches at 24 to 72 hours following evaluation. This systematic review details the completed trials that have evaluated the use of dexamethasone in this role.
The authors searched MEDLINE, EMBASE, CINAHL, LILACS, recent emergency medicine scientific abstracts, and several prepublication trial registries for potential investigations related to the research question. The authors included studies that incorporated randomized, double-blind, placebo-controlled methodology and that were performed in the ED. A fixed-effects and random-effects model was used to obtain summary risk ratios (RRs) and 95% confidence intervals (CIs) for the self-reported outcome of moderate or severe headache on follow-up evaluation.
A pooled analysis of seven trials involving 742 patients suggests a modest but significant benefit when dexamethasone is added to standard antimigraine therapy to reduce the rate of patients with moderate or severe headache on 24- to 72-hour follow-up evaluation (RR = 0.87, 95% CI = 0.80 to 0.95; absolute risk reduction = 9.7%). The treatment of 1,000 patients with acute migraine headache using dexamethasone in addition to standard antimigraine therapy would be expected to prevent 97 patients from experiencing the outcome of moderate or severe headache at 24 to 72 hours after ED evaluation. The sensitivity analysis yielded similar results with sequential trial elimination, indicating that no single trial was responsible for the overall result. Adverse effects related to the administration of a single dose of dexamethasone were infrequent, mild, and transient.
These results suggest that dexamethasone is efficacious in preventing headache recurrence and safe when added to standard treatment for the management of acute migraine headache in the ED.
神经源性炎症被认为在偏头痛的发生和持续过程中起作用。在标准抗偏头痛治疗的基础上，急诊科给予地塞米松已被用于降低评估后24至72小时复发性头痛的发生率。本系统评价详细介绍了评估地塞米松在这一作用方面的已完成试验。
作者检索了MEDLINE、EMBASE、CINAHL、LILACS、近期急诊医学科学摘要以及几个预发表试验注册库，以查找与该研究问题相关的潜在研究。作者纳入了采用随机、双盲、安慰剂对照方法且在急诊科进行的研究。采用固定效应和随机效应模型，以获得随访评估时自我报告的中度或重度头痛结果的汇总风险比（RR）和95%置信区间（CI）。
对涉及742例患者的7项试验进行的汇总分析表明，在标准抗偏头痛治疗中添加地塞米松，在24至72小时随访评估时，对降低中度或重度头痛患者的比例有适度但显著的益处（RR = 0.87，95% CI = 0.80至0.95；绝对风险降低 = 9.7%）。预计在标准抗偏头痛治疗基础上使用地塞米松治疗1000例急性偏头痛患者，可防止97例患者在急诊科评估后24至72小时出现中度或重度头痛的结果。敏感性分析通过逐次剔除试验得出了类似结果，表明没有单个试验对总体结果起决定性作用。与单剂量地塞米松给药相关的不良反应很少见，且为轻度和短暂性。
这些结果表明，地塞米松在预防头痛复发方面有效，且在急诊科添加到急性偏头痛头痛的标准治疗中是安全的。
