Clinical Medicine Research Institute, First People's Hospital of Shunde (Affiliated Hospital at Shunde, Southern Medical University), Foshan, China.
Eur J Neurol. 2013 Aug;20(8):1184-90. doi: 10.1111/ene.12155. Epub 2013 Apr 11.
Recurrence of migraine headaches after treatment is common. The evidence regarding steroids for preventing migraine headache recurrence is controversial. This meta-analysis examined the effectiveness of steroids for prevention of recurrent headaches.
Databases (PubMed, Embase and the Cochrane Library) and conference proceedings were searched for randomized controlled trials comparing steroids and placebo in the treatment of migraine headaches. Two independent reviewers assessed studies and extracted data. Relative risks (RRs) of headache recurrence and adverse events were calculated and reported with 95% confidence intervals (95% CIs).
Eight studies with 905 patients were included. Pooled analysis showed that when steroids were added to standard abortive therapy they reduced the rate of moderate or severe headache recurrence after 24-72 h of follow-up evaluation (RR = 0.71; 95% CI = 0.59-0.86). There was no significant benefit of steroids compared with placebo in the proportion of totally resolved migraines (RR = 1.11; 95% CI = 0.94-1.32). The side effects of steroids are mild and not significant except for dizziness. Subgroup meta-analysis showed that parenteral dexamethasone tends to be more effective in reducing moderate or severe recurrent headaches (RR = 0.68; 95% CI = 0.55-0.84). However, no significant differences were found between oral administration and parenteral administration of steroids (P = 0.37).
When steroids are added to standard abortive therapy for migraine headaches, they are effective and safe for preventing moderate or severe headache recurrence.
偏头痛治疗后复发较为常见。关于类固醇预防偏头痛复发的证据存在争议。本荟萃分析旨在评估类固醇预防复发性头痛的有效性。
检索了 PubMed、Embase 和 Cochrane 图书馆等数据库以及会议记录，以比较类固醇和安慰剂治疗偏头痛的随机对照试验。两名独立评审员评估研究并提取数据。计算了头痛复发和不良事件的相对风险（RR），并报告了 95%置信区间（95%CI）。
纳入了 8 项研究共 905 例患者。汇总分析表明，与标准治标治疗相比，类固醇联合治疗可降低 24-72 小时随访评估时中重度头痛复发率（RR=0.71；95%CI=0.59-0.86）。与安慰剂相比，类固醇在完全缓解偏头痛的比例方面并无显著获益（RR=1.11；95%CI=0.94-1.32）。类固醇的副作用较轻且不显著，除了头晕。亚组荟萃分析显示，静脉用地塞米松在降低中重度复发性头痛方面可能更有效（RR=0.68；95%CI=0.55-0.84）。然而，口服和静脉用类固醇之间未发现显著差异（P=0.37）。
在偏头痛的标准治标治疗中添加类固醇，可有效且安全地预防中重度头痛复发。
