100 Migraine Drugs, A to Z: dexamethasone

Dexamethasone (Decadron) is a strong corticosteroid (steroid) anti-inflammatory medication similar to prednisone and methylprednisolone (Medrol). Considering that inflammation occurs during a migraine attack and that non-steroidal anti-inflammatory drugs (NSAIDs) work well for migraines, you’d expect that a steroid medication would also be effective. And they do help, but mostly in combination with migraine drugs such as sumatriptan (Imitrex), rizatriptan (Maxalt) and other. In a blinded study, 4 mg of dexamethasone given along with 10 mg of rizatriptan was more effective than rizatriptan alone and it reduced the rate of migraine recurrence. Dexamethasone given intravenously in an emergency room setting also reduced the rate of migraine recurrence.

The usual oral and intravenous dose of dexamethasone is between 4 mg and 12 mg. Potential side effects include anxiety, or feeling “hyper”, depression, insomnia, dizziness, upset stomach, increased blood sugar, and other. The multitude of potential side effects is why we first try triptans (tablets and injections), NSAIDs, and nausea medications, before adding steroids. When these drugs not help and intravenous treatment is called for (and the patient is able to come to our office), before giving steroids we try magnesium sulfate, ketorolac (Toradol), ondansetron (Zofran) or metoclopramide (Reglan), and dihydroergotamine (DHE-45). We may also give nerve blocks or a sphenopalatine ganglion block to avoid giving a steroid medication.