Randomized Controlled Trial of Intravenous Dexamethasone to Prevent Relapse in Acute Migraine Headache
Bibliographic record
Abstract
OBJECTIVES: Migraine headache is a common presentation in the emergency department (ED). Inflammation is thought to play a role in the pathophysiology of migraine and there is conflicting evidence regarding the effect of corticosteroids on reducing early recurrences. We conducted a randomized clinical trial to test the hypothesis that dexamethasone (DEX) reduced headaches after discharge and examine the factors associated with relapse. METHODS: Consenting adults (18 and older) presenting with acute migraine at 4 EDs were enrolled. In addition to standard intravenous (IV) abortive therapy, using concealed allocation patients were randomized to receive IV DEX (15 mg) or placebo (PLA) in a double-blind fashion. Relapse was defined as a return to the ED, an urgent clinic visit, or a headache that precluded normal activity reported during follow-up telephone interviews 48-72 hours and 7 days after ED discharge. Intention to treat was used for all final analyses. RESULTS: A total of 130 patients were randomized; 126 patients are included in the analysis (one patient left prior to treatment and 3 enrolled twice); 64 received DEX and 62 received PLA. Mean age was 35 years, 81% was female; most (77%) suffered from headaches at least monthly. On a 10-point visual analog scale (VAS), the median pain scores were 8 at presentation, and 2 at discharge. At 48-72 hours, relapses occurred in 14/64 (22%) in the DEX group and 20/62 (32%) in the PLA groups (OR = 0.6; 95% CI: 0.3-1.3). By day 7, 18/64 (28%) in the DEX group had relapsed, compared with 25/62 (40%) in the PLA group (OR = 0.6; 95% CI: 0.3-1.3). Controlling for treatment assignment, relapse was more common when headache pain was incompletely relieved (VAS > 2) at ED discharge (OR = 2.2; 95% CI: 1.1-5.4). CONCLUSIONS: The overall relapse rate differed from those previously reported; however, DEX failed to reduce headache relapses after ED discharge. Relapse was closely associated with incomplete pain relief at discharge. Further research is needed to determine the factors associated with migraine relapse.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".