There has been much discussion lately in regards to steroids to abort a long migraine cycle and whether one type is better than the other. Two different names of steroids have been brought up - methylprednisolone and dexamethasone. Can you please explain the differences between these medications, if there is one. Also please explain how steroids are beneficial in treating a long migraine cycle and if there is any down side to using them. Many thanks, Roni .
Methylprednisolone and dexamethasone are both synthetic glucocorticoids (steroids) with many similar uses. While there are some differences in dosing schedules and length of effect, for the most part, they are similar in action. The evidence is not entirely clear for the use of these medications in the treatment of migraine, especially in the treatment of a refractory migraine - a migraine that isn’t responding to treatments. They are commonly used and subjectively seem to be reasonably effective, but good randomized studies have not convincingly shown their benefit. There is some evidence that dexamethasone, when given with other migraine abortives, can help prevent recurrence of migraine within 72 hours.
Despite a lack of clear evidence, the assumption is that steroids are effective in breaking a prolonged migraine due to their potent anti-inflammatory properties. While they may be a good option on occasion, care must be taken to avoid developing toxicities from steroids, such as elevated blood sugars, weight gain, bone loss, and even avascular necrosis of the hip (this is a rare but serious problem). More common side effects include insomnia, fluid retention, irritability, and GI distress.
Thank you for your question,
Dave Watson and Teri Robert
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Do you have questions about Migraine? Reader questions are answered by UCNS certified Migraine and headache specialist Dr. David Watson, and award-winning patient educator and advocate Teri Robert. Questions may be submitted via our submission form. Accepted questions will be answered by publishing the answers in our Ask the Clinician column. For an overview of how we can help and questions we can and can’t answer, please see Seeking Migraine and Headache Diagnoses and Medical Advice.