Department of Pharmacy Practice, Wayne State University, Detroit, MI 48201, USA.
Postgrad Med. 2012 May;124(3):110-5. doi: 10.3810/pgm.2012.05.2554.
Patients with migraine headaches are commonly encountered by clinicians both in the clinic and in the emergency department. Migraines impose a significant financial burden on patients, caregivers, and society. Up to 49% of patients treated acutely for migraine headache will have a recurrence within 72 hours. Recurrence of migraines is dependent on a number of factors, including the choice of abortive agent, age, sex, and initial severity of the migraine. Dexamethasone has been proposed and studied as a medication that may decrease the frequency of such recurrences of migraine headaches in affected patients. Dexamethasone is a corticosteroid that has been proposed to prevent recurrence of migraines through its prevention of neurogenic inflammation. Initial trials, with less-than-ideal methodology, showed large decreases in the number of patients experiencing recurrent migraines. Later randomized controlled trials revealed mixed results, with subsequent meta-analyses showing an overall benefit in the prevention of recurrence of migraines. These meta-analyses suggest that dexamethasone will prevent recurrence in about 10% of patients, although trials that used higher doses of dexamethasone and followed patients for ≥ 72 hours showed a larger benefit. Very few adverse events were reported in the randomized controlled trials following a single dose of dexamethasone. Given the benign side effect profile and wide tolerability to a single high dose of dexamethasone, it appears to be a safe and modestly effective addition to standard migraine abortive therapy for the prevention of migraine recurrence. Dexamethasone should not be used in patients with non-migraine headaches or contraindications to steroids. Further studies should help delineate if dexamethasone can be tailored to specific patient populations and hence enhance its therapeutic effectiveness.
偏头痛患者在临床和急诊科都很常见。偏头痛给患者、护理人员和社会带来了巨大的经济负担。高达 49%的偏头痛急性治疗患者在 72 小时内会复发。偏头痛的复发取决于多种因素，包括选择的止吐剂、年龄、性别和偏头痛的初始严重程度。地塞米松被提出并研究为一种药物，可能会减少受影响患者偏头痛复发的频率。地塞米松是一种皮质类固醇，通过预防神经源性炎症来预防偏头痛的复发。最初的试验方法不够理想，表明接受治疗的患者中偏头痛复发的人数大幅减少。后来的随机对照试验结果喜忧参半，随后的荟萃分析表明偏头痛复发的总体预防有一定的效果。这些荟萃分析表明，地塞米松将预防约 10%的患者偏头痛复发，尽管使用更高剂量地塞米松并随访患者 72 小时以上的试验显示出更大的益处。在单次使用地塞米松后的随机对照试验中，报告的不良事件很少。鉴于地塞米松的副作用谱良性且对单次高剂量的耐受性广泛，它似乎是一种安全且适度有效的偏头痛急性治疗辅助药物，可预防偏头痛复发。地塞米松不应用于非偏头痛性头痛患者或对类固醇有禁忌症的患者。进一步的研究应该有助于阐明地塞米松是否可以针对特定患者群体进行定制，从而提高其治疗效果。
