Emergency Treatment of Intractable Migraine




The treatment of refractory or prolonged migraine is a difficult problem for the physician and patient. Treatment varieswith physician and location, but widely accepted is therapy with an injectable analgesic in combination with asedative/antimetic and/or ergotamine.Since prolonged migraine headache is said to be associated with cranial vascular inflammation, the addition ofcorticosteroids to treatment may enhance relief. An analysis was conducted of 162 patients who were treated with andwithout steroids for intractable migraine headache in the emergency department of a large community hospital.Patients were divided into three groups. Group I consisted of 73 patients treated with meperidine and promethazine;Group II, 32 patients treated with dihydroergotamine and meperidine; Group III, 57 patients treated with meperidine,promethazine and dexamethasone. All patients were telephoned 24 hours after treatment to determine the degree ofheadache relief. Twenty-one patients (29%) from Group I; 12 patients (37%) from Group II; and 41 patients (72%) fromGroup III reported marked relief.From this limited study, it appears that the inclusion of dexamethasone in the treatment of intractable migraineheadache is of benefit.