Background: Headaches is one of the most common complaints of children in the ED and the
treatment of pediatric migraine is largely based on extrapolation data from adult studies,
limited pediatric trials, clinical experience and expert consensus. Despite the fact that
dexamethasone has already been proven effective to reduce recurrence and is currently used in
treating adults with migraine, no studies have looked at its use in the treatment of
childhood migraine where relapse rate of about 50% are described in the 48h following
successful treatment in the ED.
Objective: To examine the effectiveness of parenteral dexamethasone at preventing migraine
recurrence in children and to study the risk factors for migraine relapse after discharge
from the ED.
Methods: This a randomised, double-blind, placebo-controlled clinical trial among all
children 8 to 17 years of age with a presumptive diagnosis of acute migraine and treated with
a standardized protocol in the ED of the CHU Ste-Justine, a tertiary care pediatric hospital.
After the parenteral administration of prochlorperazine or metoclopramide and
diphenhydramine, the patients were randomised to receive either dexamethasone or a placebo.
They were excluded from the intervention if they had a known allergy or absolute
contraindications to receiving parenteral corticosteroids, if they were already on a
corticosteroid regimen or if they did not respond to the initial abortive migraine therapy.
All included patients were discharged on a 48-hour course of naproxen and with a headache
diary to fill out and return. The primary outcome was the incidence of relapse in the 24-48h
following discharge from ED. The secondary outcomes evaluated were the mean level of pain,
the use of rescue medication after ED discharge, the return rate to the ED or the visit to a
health care professional within 7 days including hospitalisation. The associated symptoms,
the adverse events after parenteral corticosteroids and the risk factors for migraine relapse
were also evaluated. A telephone follow-up was made to ensure the headache diary was
completed and returned.