Dexamethasone in a Migraine Emergency

One migraine emergency room treatment that has become a lot more common is dexamethasone. But what exactly is it, and why is it used?

Dexamethasone is a type of steroid called a corticosteroid (not to be confused with the other type – anabolic steroids are the ones that are sometimes used illegally by athletes). Corticosteroids are similar to cortisol, which your body produces naturally.

Like other corticosteroids, dexamethasone is used as an anti-inflammatory. We know that inflammation can be a good tool that your body uses, but inflammation can also get out of control. Dexamethasone can actually be life-saving when inflammation threatens your body’s organs, such as kidneys. It may also be used for less serious situations, such as to lessen inflammation when you’re having your wisdom teeth removed.

In the case of headache and migraine, anti-inflammatories are of course very common, helping to decrease that hot swollen pain. But as doctors began to give it to patients, they started to notice another benefit. Patients who were given dexamethasone were less likely to get another migraine / headache in the near future.

Once a migraine attack is serious enough to land you in emergency, doctors are concerned about a couple of things. First, they don’t want the symptoms to go on and on – they want to see the migraine attack stop. But they also don’t want to see you back in emergency a day or two later.

Dexamethasone is by no means a silver bullet – it would probably only stop that new headache in a minority of patients. But that minority is important, and along with its other benefits, there’s a good reason why many doctors are using it as a part of their treatment.

Avoiding another headache will also help you avoid taking more medication. But of course researchers are concerned that some patients will end up taking too much of the corticosteroid instead. In other words, no problem if we help that patient who has a one-time emergency room visit. But what if they come often? Too many doses of corticosteroids can cause problems. It can weaken your immune system. It can lead to osteonecrosis (a loss of bone tissue).

But used with care, doctors are finding dexamethasone to be useful. In fact, researchers in Canada are investigating its use in children with migraine as well (if you’re interested in taking part in this trial, here’s more information).

Learn more about some of the treatments you may find in the emergency room here.