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.

18 comments
  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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?

  11. 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.

  12. 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

  13. 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
  14. Jake Bouchard says: 08/07/20144:49 pm

    Dr. Mauskop,

    Hello,

    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
    jake.bouchard@wne.edu

  15. 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.

  16. 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.

  17. 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).

  18. 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.

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