Treatment of Status Migrainosus with Oral Dexamethasone in an Outpatient Setting (P1.160)

Abstract

Objectives: A retrospective chart review of outpatients treated with oral dexamethasone for status migrainosus. Background: Corticosteroids are often used as abortive therapy of acute migraines and have been reported in anecdotal studies for status migrainosus. Most reports show that treatment was obtained in Emergency Rooms or as inpatients. There have been some small case studies with DHE and intravenous dexamethasone but no reports with oral dexamethasone. Methods: A retrospective chart review of patients who presented to our headache center with Status Migrainosus who failed baseline preventative medications and at least 1 abortive medication. Patients received 4mg oral dexamethasone BID for 4 days and were allowed to continue with current preventative medication but no other abortive medications. Results: We reviewed 20 charts. All patients were female with ages between 18-70. The average number of preventative medications used was 1.6 and the average abortive medications was 1.8. Average length of headache prior to initiation of oral dexamethasone ranged from 3 days to 3 weeks. 80[percnt] of patients showed improvement, with pain scores less than 2/10 and 60[percnt] were pain free. 6 patients had response by day 1, 6 patients responded by day 2, 3 by day 3. 1 patient required retreatment and responded by day 8. There were 4 patients that reported no benefit after 4 days of treatment. Side effects were minimal with 16 patients reporting no side effects, 3 patients reporting restlessness/insomnia, 1 patient reporting nausea and malaise. Conclusions: Oral dexamethasone at 4 mg BID for four days showed significant improvement in pain levels in 80[percnt] of patients with status migrainosus treated in an outpatient setting. The treatment was well tolerated with minimal side effects, is cost effective, and easy to administer. Larger controlled studies are needed to confirm the effectiveness of oral dexamethasone in the outpatient setting.

Disclosure: Dr. Bland has nothing to disclose. Dr Levine has received compensation from Lilly, Pfizer, Griffols, Baxter, Nufactor, Mallinckrodt, and Corinthian Reference Labs.