Trial reportHeadache2026
Randomized controlled trial of intravenous dexamethasone to prevent relapse in the treatment of migraine in a pediatric emergency department.
Trial report in Headache, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study aimed to evaluate whether a single dose of intravenous dexamethasone, when added to standard abortive therapy, reduces relapse of migraine after emergency department (ED) discharge in children and adolescents.
backgroundMigraine is a leading cause of headache presentations to the ED for children and adolescents. Although corticosteroids have been suggested to reduce relapse in adults with acute migraine, their efficacy in children remains unknown.
methodsWe conducted a randomized, double blind, placebo-controlled trial at the tertiary pediatric ED of the CHU Sainte-Justine in Montréal, Canada. Patients 8-17 years old with acute migraine attack requiring intravenous rescue therapy (metoclopramide with diphenhydramine) were randomized to receive dexamethasone (0.6 mg/kg iv, max 15 mg) or placebo before discharge. All participants were discharged on oral naproxen for 48 h. The primary outcome was relapse within 48 h, defined as recurrence or worsening of headache after initial improvement. Secondary outcomes included pain scores, return to school and activities, health care revisits, and adverse events. Analyses were performed using a modified intention-to-treat approach including all children who provided data for the primary outcome.
resultsBetween July 2013 and February 2025, 116 patients were enrolled, and 87 patients (75%) provided outcome data at 48 h. Median age was 14 years, and 85 patients (73%) were female. Relapse occurred in 39% (16 of 41) of the dexamethasone group versus 44% (20 of 46) of the placebo group (risk difference: -4%; 95% confidence interval, -32% to 24%). Pain scores, return to school, functional recovery, and health care consultations did not differ significantly between groups. Adverse events were infrequent and mild in both arms.
conclusionsIn this small clinical trial of children and adolescents with acute migraine attack treated in the ED, adjunctive dexamethasone did not reduce relapse rates nor improve functional outcomes compared with placebo. Although limited by low statistical power, these findings raise questions about the routine use of dexamethasone in migraine management of children and adolescents.
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