Steroids for migraines

Steroid medications can be very effective for migraine headaches that fail to respond to other medications. Steroids, such as prednisone, dexamethasone, methylprednisolone have many potential serious side effects if taken for a long time. We know about these long-term side effects from patients with asthma, arthritis, lupus and other conditions who have take steroids daily for months and even years. However, these medications are relatively safe if taken for only a few days. If a severe headache does not respond to Migralex, sumatriptan, (Imitrex), or other medications, I prescribe a two-day course of dexamethasone. The usual dose is 8 mg daily for two days. Other doctors prescribe a six-day course of methylprednisolone (Medrol Dosepak). However, if a headache completely resolves after two days, it seems unnecessary to continue this medication for the full six days. In the office, we also give intravenous dexamethasone which provides faster relief than tablets. Another indication for steroids is for cluster headaches. A ten-day course of prednisone (starting with 100 mg and reducing by 10 mg every day) can sometimes stop the entire cluster period. Unfortunately, for some cluster headache sufferers headaches return as soon as the dose of prednisone is lowered. If no other preventive medication, such as verapamil, lithium, topiramate (Topamax) or divalproex (Depakote) work, some patients with severe attacks are willing to accept the risk of long-term side effects of steroids. Some of these side effects are weight gain, diabetes, stomach ulcers, glaucoma, high blood pressure, and osteoporosis.

  1. Dr. Mauskop says: 05/14/20165:18 pm

    I would ask your doctor for sumatriptan or another triptan, which you can combine with an NSAID, such as naproxen. Rebound from caffeine and caffeine containing drugs is real, but triptan a and NSAIDs rarely cause rebound. This post on daily use of triptan a is the most commented on with over 150 comments.

  2. Samantha says: 05/14/20163:00 pm

    I am currently dealing with rebound migraine headaches that have been ongoing for 2 weeks. My doctor has cut me off of all my meds and put me on a round of prednisone. She gave me a muscle relaxer and said I can continue with gabapentin as needed and benadryl to help sleep. I am still suffering through the day with horrible pain. What can I do to help alleviate some of the discomfort while I wait for the steroids to kick in?

  3. Dr. Mauskop says: 03/21/20168:02 pm

    Yes, Botox can be very effective for the prevention of migraines. It doesn’t help everyone, but in my experience, 70% obtain relief. Although Botox does completely prevent all migraines in some patients, the majority of people find that the frequency and/or the severity of their attacks dramatically improves, even if the headaches are not completely gone. You should also keep in mind that the first treatment may provide only 20-30% of relief, but the next one could provide 50% and the one after, 80% relief. There is a small percentage of lucky patients for whom the first treatment stops all of their attacks.

  4. margo says: 03/21/20166:25 pm

    Thank you for your information and time Dr. Mauskop. My trigger for migraine attacks is the flourescent lighting at my work (who also pays my insurance and dr bill) so I cant avoid it. Somehow I have to deal with it. The ONLY time I get migraines is around those lights. In order to help deal with it, I take triptans and starting the 10 day steroid treatment, but Botox was mentioned here and by my neuro. Does botox take the pain completely away? Can it stop the migraine cycle altogether? I know the flourescent lights are not bad of themselves and there could be an underlying problem. So far the MRI/MRA showed everything normal as did all my blood tests.

  5. Dr. Mauskop says: 01/30/20164:08 pm

    The doctor who prescribed dexamethasone should be available by phone or another doctor should be covering for her. Otherwise, I would look for a doctor who is available to answer urgent questions like yours. I cannot give specific advice to patients I haven’t seen, but the general rule is, if something makes the headache worse, stop it.

  6. Angelica says: 01/30/20163:57 pm

    Hello, I am writing because both my Mom and I struggle with severe Migraines, but my Mom’s migraines are definitely worse. She has spent the last 2 weeks with migraines every day so she scheduled an appointment with her neurologist who prescribed a 6 day doseage treatment of steroids (4mg each). We are desperate because we have never heard of treating migraines this way and after starting the dose as prescribed the first day her headache got worse. The pain got so bad that we took her to the emergency room not knowing if we can give her any kind of pain medicine while on the steroids or if she should stop them all together. The Doctors in the emergency room could not advise whether to stop the treatment or not and prescribed her Vicodin. Her Neurologist is unreachable and only sees patients at her clinic every 3 months! We’re looking for a second opinion or someone to give us a definite answer whether she should continue with the steroids or not but it is Saturday and there are no clinics open. Please help.

  7. Dr. Mauskop says: 01/17/201610:23 am

    You need to ask your doctor. But in general, steroids are used for a prolonged episodic migraine which does not respond to migraine medications, such as sumatriptan, and not for chronic migraines. An exception could be a chronic migraine with a sudden worsening of pain.

  8. Darlene says: 01/17/20162:16 am

    Decided not to take dexamethasone after reading other reviews on this and other steroid horror stories. Seems to be futile.

  9. Darlene says: 01/17/20161:46 am

    Question was not answered. Chronic migraines. Just finished memedrol dose pack lastnight. Headache beginning tonight. Can I take a 4mg dexamethasone tablet previously prescribed? Also on 175mg topiramate, 150mg lamotrigene (depression) 1x and 2mg klonopin 1x daily.

  10. Dr. Mauskop says: 01/13/20169:09 am

    You are most likely suffering from cluster headaches, even if you don’t have all of the symptoms. I would ask your neurologist about trying verapamil instead of Topamax to prevent these headaches. To stop individual attacks, Imitrex injections and oxygen can be very effective. Botox can be also effective. Magnesium supplementation can be effective for both migraines and cluster headaches.

  11. QuitaC2011 says: 01/13/20161:50 am

    Hi Dr. Mauskop,
    I recently read your blog and found it very insightful. I am 22 year old recent college graduate. I am kind of searching for answers to figure out what’s causing my headaches and what the best possible treatment could be. I started having migraine like headaches when I was a kid. I would get the throbbing head pain, sensitivity to movement, sensitivity to smells. I rarely had nausea though. Only when my headache were extremely severe did I have nausea, along with light headness, and feeling overall really unwell. My headaches begin to change though around my pre-teen years. I started getting this horrible pain behind my right eye. The pain would be so bad at times I would cry. I would pace and even rock back in forward. I would try everything to make it go away. This headache would go away and reoccur the next day, and do the same thing for day for about two weeks. Then eventually I would have months where I felt fine and only a headache every now and then. Then just when I thought they were gone they would reoccur. As of right now I still get these same headaches, and they are not as severe, they no longer make me cry. They get pretty bad most days and I have to completely stop what I am doing to lay down for a while because the pain hurts so bad, and my right eye is so sensitive to light. It only effect my right eye.I have been placed on topomax to help with the flare ups, but even at 100mg, I am getting a flare up about 5 months out of a year. And my last flare up hasn’t gotten better. I have done research on on cluster headaches and I don’t meet the full criteria. Though there are time my headaches do reoccur multiple times a day. I have also done research on other headache disorders. It doesn’t really meet the criteria of a migraine but my neurologist thinks that what it is. The thing is my headaches usually last around 15mins- 6hrs. During my current headache cycle they have been lasting around 2hrs usually with meds or with rest. Most times they last longer with rest and reoccur if I only take rest. Also they occur in all hours of the day. They occur during the morning and the night..and even have been waking me up at night. I have considered the possibilty of tension headaches..but it only effect the one side of my head..mainly my eye and radiates to my frontal region. Also I don’t I have one constant headache every day, every day I end up with a new headache sometime during that day, whether it be morning, night, school, home etc. I read this blog to inform myself on what to expect from upcoming appointments and try to know as much as possible about what medications I could be interacting with. My question for you is do you have any advice or possible insight of what could be going on with me. I am currently on headache 22? So I am a bit desperate for answers


  12. Dr. Mauskop says: 12/15/201512:07 am

    Chiari malformation is often accompanied by headaches and it is usually easy to diagnose on a routine MRI scan of the brain. If the Chiari malformation is very mild (it is measured in millimeters) it does not cause headaches, however, some neurosurgeons still offer surgery in the false hope that it will relieve headaches.

  13. Devin Bostick says: 12/12/20157:12 pm

    I understand that temporal arteritis is not a possibility based on my workup. How about Chiari malformation? I am looking into this closely with the Chiari Institute in Long Island. Why would a migraine last for 9 months without subsiding, only getting worse, without nausea or sensitivity to light or sound, not triggered by anything in particular (I don’t take medications, drink alcohol, tea, or coffee, or smoke and have healthy diet), and worse while lying down and with Valsalve manuevers?

  14. Dr. Mauskop says: 12/08/201510:18 pm

    Temporal arteritis at the age of 23 with normal blood tests is not a possibility, but chronic migraine is. Autoimmune diseases are diagnosed by blood tests and if all of the tests are normal, it is also extremely unlikely. Botox is the only FDA-approved treatment for chronic migraines, but needs to be repeated at least twice to see if it helps. Herbal products such as Boswellia and meditation are also worth trying.

  15. Devin Bostick says: 12/07/201511:43 pm


    I am a 23 year old male. For the past 9 months I have had an odd sensation of pressure and pain over an artery on my head near my temple above my right ear. The pain is worse is the morning and lasts all day. It can be sharp if I touch or palpate the exact artery. The pain has gotten worse since March this year. I have had MRI of brain and cervical spine, CTA of head and neck, rigorous blood work (ESR, CRP, autoimmune antibodies (ACA, ANCA, RF, etc), lyme disease, CBC, vitamins), ultrasound of artery, lumbar puncture, and biopsy of inflamed artery near painful artery -> all tests were normal. I have been to a headache clinic, neurology department at Mount Sinai hospital in NYC for 5 days, and to numerous neurologists, ENTs, primary care doctors, and one rheumatologist.

    My exact symptoms are detailed below:
    1. Dull ache on affected side of head near temple and around ear. Dull ache worsens when bending over or tilting head or leaning body to affected side.
    2. Dull ache develops into constriction-like sharp pain when temporal artery is touched or pressed on (I can feel the pulsation under my skin and after feeling this I have pain; there is no pain anywhere else on my head except for local pain directly over this temporal artery elicited by soft touch and movement). This sharp pain lingers after touching artery and worsens when tilting head to affected side.
    3. Scalp tenderness
    4. Head pain worsens when lying down.
    5. Pressure in forehead and in upper front and back teeth
    6. Pressure behind nose near top and bottom of septum that worsens when bending over.
    7. Pain in head when talking, chewing too hard, opening mouth to wide, and singing.
    8. Throbbing head when lying down, heart beat moves whole body and head, very annoying.
    9. Swishing noise with heartbeat in ear when lying down (pulsatile tinnitus?)
    10. Pain in temple is relieved when pressing on artery in front of ear and stopping blood flow to superficial temporal artery above ear and in temple region.
    11. Hurts to wear glasses
    12. Fatigue in arms and legs
    13. Stiffness and extra tiredness in morning
    14. Tongue pain
    15. 20 lb weight loss over 3 months

    I have taken migraine medications (triptans, Depakote, botox, analgesic injections) with no relief. I have taken trigeminal neuralgia medications (oxycarbezepine, amitryptiline) without any relief. The pain is continuous and only subsides with high dose prednisone (60 mg/day), which has been prescribed to me twice in the past month for 7 day tapers by my primary care doctor out of desperation. Doctors are hesitant to prescribe me steroids because of the serious side effects from them, but I cannot live without them because the pain is too severe when I don’t take them.

    Could this be some kind of strange migraine? Could this be temporal arteritis (since the artery itself is in pain) even though I am so young (23) and all my tests have been negative? I am at wits-end with the pain and no doctor seems to have any ideas what could be causing this mysterious pain and body symptoms for so long without ceasing. I am worried if I have an underlying inflammatory/autoimmune condition that is causing this undiagnosed, unsuccessfully treated, and debilitating artery pain.


  16. Dr. Mauskop says: 08/10/20157:04 pm

    It’s always best to ask your doctor, but if prednisone works, you will not need Imitrex. Although 10 mg seems like too low of a dose to break a stubborn migraine.

  17. Patti says: 08/10/20156:54 pm

    I have been diagnosed with chronic migraines, my neuro and I have tried all the preventatives (botox, beta blockers, topamax etc.) I have been taking imitrex daily as I have had a very stressful period in my life. My neuro prescribed prednisone (10 mg) to use to cut the cycle. I was wondering if I am suppose to STOP taking the imitrex cold turkey while I am taking the prednisone or do I taper off while taking the prednisone.

  18. Dr. Mauskop says: 07/10/201510:00 am

    You may want to ask your doctor about trying tizanidine, starting with 4 mg nightly and gradually escalating the dose. Other, less frequently used drugs for chronic migraines include Namenda and Nardil. Magnesium Boswellia, CoQ10 are some of the non-drug treatments to consider.

  19. jackie says: 07/09/20159:55 pm

    I have been on all classes of preventative for migraines. Beta blockers, calcium blockers, anti-convulsives, herbal, amitriptaline, nothing works. I have had 2 rounds of botox and that doesn’t seem to do anything. I am getting relief with sumatriptan when I get the headaches. Now on steroid for 3 days since i have had a headache for 4 days in row and dr. doesn’t want me to take more sumatriptin. Any thoughts on what I can try for preventative now? Getting 3rd round of botox in 2 weeks. Thanks.

  20. Dr. Mauskop says: 11/19/20147:51 pm

    Getting off Excedrin and all caffeine can make a dramatic difference and if headaches persist, Botox is the most effective and the safest preventive treatment for chronic migraines.

  21. I have had headaches daily since I am 12, I am no 50. I take sumatriptans that have changed my life because they do give relief. However lately I have had seven day migraines particularly stemming I right eye down to right neck. Got toradol, decadron,rega says: 11/13/20145:01 am

    I have always used excedrin, today I had a nerve blocker. I am on the current regime of topamax, avorstatin, venlafaxine, nifedipine for raynauds, synthroid for hypothyroid, sumatriptans that of course changed my life. However I had a doozy headache lately. My right eye and down my right side of face and neck. That is where the nerve blocker comes in and an infusion of toradol, decadron, and reglan. That infusion Did nothing. Any suggestions to curb these daily headaches?

  22. lisa says: 10/02/20149:35 pm

    I saw Dr finally, well after urgent care because the pain was unbearable that day. Shot of toradol didn’t help. The headaches do respond to Tylenol migraine, takes pain to a dull roar.

  23. lisa says: 10/02/20149:31 pm

    I dont have the typical migraine symptoms so do not believe that’s what my headaches are. Usually 3 days of unable to function pain and it’s gone. This time after 21st days, I say dr. Given prednisone for 5 days 50mg. Does this sound right?

  24. Erin says: 09/17/20144:13 pm

    I have been on Tramadol for about 6 years now for migraines. I was having migraines that left me unable to function – I have to work and I have kids so this is not possible. My neurologist at the time and I tried everything…Imitrex, Maxlat, various combinations of medications and I have changed my entire diet. I take the steroids (predinsone) maybe twice a year for rebound headaches as the tramadol has helped so much. I take 100mg every day as I have been directed for 6 years. It seems like many doctors are reluctant to let me continue with this regime. Is this really that bad? I’m made to feel like a drug addict for wanting to take something that as helped for so long.

  25. Dr. Mauskop says: 08/18/20147:18 pm

    I cannot give any specific advice to anyone, but would suggest one more test – “RBC magnesium”, which is different from regular “serum magnesium”. As far as treatment, the best option is Botox injections, which is now FDA-approved for chronic migraines and therefore is covered by most insurance companies. For my patients, I also often combine a drug like Maxalt (but for some, Imitrex, Zomig, Relpax, or Amerge work better) with Migralex (my aspirin+magnesium combination, available at CVS for tension, menstrual, sinus and other types of headaches).

  26. Melissa Barrow says: 08/18/20145:10 pm

    I am a 25 y/o female experiencing migraines for 7 months now. Every test possible has been done on me already and have came back normal: CT, MRI, MRA, LP, CBC, Vit D, Nuc AB, Thyroid, T &S, HCG, Cortisol AM, Vit B12 + Folate… I mean EVERYTHING! I was on Imitrex but it made the migraines worse. In and out the ER almost 4 times a week, 2 of Dilaudid doesn’t touch the pain. I am currently on 200mg Topomax with Maxalt, Zofran, and Xanax for break through pain and my doc just start me on 5 day steroid pack. Absolutly NOTHING is helping! Any ideas? Ive seen 2 specialty Neurologists, nobody has answers.

  27. Dr. Mauskop says: 08/07/20145:04 pm

    There are not a lot of good studies on steroids for migraines. We think they work because migraine is proven to involve inflammation and steroids are the most powerful anti-inflammatory drugs.

  28. Jake Bouchard says: 08/07/20144:49 pm

    Dr. Mauskop,


    I am a pharmacy student at Western New England University and also suffer from migraines. I am currently on a prednisone taper. I cannot locate evidence in the literature to support that steroids are a successful treatment for migraines, but have read many testimonials and you seem to have had much success with your prescribed regimens. How did you conclude to prescribe steroids initially to your patients and how would the drug have such a quick effect to snap the cycle? The results seem extremely beneficial! I hope you have the time to respond to my questions and that you are having a wonderful summer.

    I truly appreciate your time and expertise,

    Jake Bouchard
    Western New England University
    Doctor of Pharmacy Candidate Class of 2017

  29. I have used courses of 4 mg dexamethasone 2x day to successfully break migraine cycles. The insomnia and jitteriness are awful. This last time, I took only on e a day for three days and still cannot sleep. How long does if take to leave my body? I fear th says: 07/30/20143:10 am
  30. The Varying Levels of Migraine says: 04/23/20147:38 am

    I and couldn’t find anything about using a Steroid to kill a migraine. Then, I finally found this article. And another one here about Steroid Injections for cluster

  31. Dr. Mauskop says: 03/25/20146:14 pm

    Temporal arteritis is extremely unlikely. It could be either migraine or new daily persistent headache. I cannot give any specific advice on medications without seeing the person and getting the details of family history, medical history, other symptoms, test results, etc.

  32. Aris Sharp says: 03/25/20145:57 pm

    Not sure if you are still responding but if you are,
    I’m a 25 year old male in relatively good shape but for the past month straight I’ve had a right temple headache, that is constant, does not come or go, just stays. Pretty localized to that right temple. Cat scan was normal. Doctor I saw over the weekend prescribed me a Medrol pack. But my primary prescribed me Triptans. Which should I take? Do you think I’m having migraines? I’ve never had them before.. Could it be a rare case of Temporal arteritis since I’m so young?

  33. Dr. Mauskop says: 12/20/20135:22 pm

    After two days without Fioricet seizures or any other serious problems are unlikely. However, rebound headaches are also unlikely if you took Fioricet for only a few days each month, unless you were also consuming caffeine in other forms. While in the hospital, intravenous infusion of magnesium could provide quick relief. Otherwise, taking magnesium by mouth daily may prevent future menstrual headaches.

  34. dee west says: 12/20/20135:10 pm

    I recently spent 4 days in the hospital. I was experiencing migraine headaches, Mri/Mra was normal. I’ve taken fioricet for 6-7 years, more so around my cycle time; i take 2 every 4hrs for 3-5 days, then a few other times during the month. I’ve never experienced such severe pain. The neuro who made rounds while i was in the hospital..indicaited i was experiencing REBOUND headaches and to STOP the fioricet. I have read a lot of frightening posts online about going COLD turkey off of this medicine; SEIZURES. I’ve express my concern with the neuro, he replied: STAY OFF OF THE INTERNET, different people experience different things. He’s prescribe MEDROL PAK 21’S and ELAVIL 10MG. Would you advice going COLD turkey off of the feriocets? My last dose were wednesday, i took 2.

  35. Stan lumley says: 01/17/20139:54 am

    Dr. Mauskop: This is my presenting medical problem I have had daily cluster head aches since mid to late September 2012. I wake up every morning anywhere from 2-4 am with a severe pain in my left eye radiating to the left side of the neck, into the left shoulder base of skull and neck. I will also run a temp from 97-100 degrees with chills and severe sweats. I was given various antibiotics including oxycyline thinking it might be caused by deer ticks. Now they have done numerous blood test and can find nothing wrong. Yes I had the eyes checked perfectly normal. The Mayo Clinic had diagnosed me with cluster head aches befor but they wer nothing like what I have now. The doctor prescribed Toprimate 25mg 1 tablet at night which helped me sleep better. Sumatriptan 50 mg a max of 2 x a day which did nothing to ease the pain. After 9 days the doctor put me on Methylpredonisolone dose 4mg tablets 6 the first day reducing down to 1 4 mg tablet. The methylprednisolone reduced the paing a little the first day. Day 2 up at 4 am with cluster head ache. Should I have been given a stronger dosage of Methylprednisolone and can it be taken with the Toprimate. Any suggestions to help with the cluster head aches would be greatly appreciated. Thank you for your consideration and cooperation.

  36. Dr. Mauskop says: 12/09/201210:57 pm

    You may want to ask your doctor about getting Botox injections to break your cycle of rebound headaches. An intravenous infusion of magnesium can sometimes also break a persistent migraine.

  37. Joy says: 12/09/20129:33 pm

    I have had migraines for years and medrol packs have always broken the cycle of rebound headaches. However recently I had an experience where Imitrex injections only worked temporarily do the doctor gave me the medrol pack. It took three days to work. Where it normally works the first day. When the sux days of the pack was over the headaches returned so he gave me another pack. Immediately after I finished that last pill the headaches have returned with such severity I had to take an Imitrex injection just to sleep last night. I honestly do not understand. I have never faced headaches retuning like this. Can you make some suggestions? I am on zonagran as a daily preventative.

  38. Dr. Mauskop says: 11/07/20125:48 pm

    Unfortunately, steroid medications have many potential side effects, which can be very serious. Taking prednisone, methylprednisolone (Medrol), or dexamethasone (Decadron) for up to two weeks for a prolonged or refractory migraine or for cluster headaches is considered relatively safe. However, some people develop side effects even after one day. If a small dose of prednisone (5 – 10 mg) is very effective, you need to discuss with your doctor investigating possible underlying causes of your headaches, such as temporal arteritis (if you are over 55) or another inflammatory condition.

  39. Anne says: 11/01/20129:11 pm

    The medrol dose pack will take my headaches away for the entire time I am on it. To break a bad cycle of headache, have you ever had a patient go on a low dose of prednisone for a month? I would like to try this to see if it could help. The problem is, i think I would just go back into my chronic mode of headaches as soon as I finished.

  40. Dr. Mauskop says: 08/22/20124:45 pm

    I usually recommend taking steroids for migraines on not more than 2-3 days a month and sometimes combine it with a triptan or Migralex (aspirin with magnesium) or an NSAID.

  41. Ana says: 08/22/20128:19 am

    How often can you utilize this treatment? More than once per month? It did abort a 25 day migraine. Also do you ever use Dexamethasone 4mg as part of abortive tx with a triptan and NSAIDS? Thank you.

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