Can Higher Doses of Dexamethasone Help With Migraines in the Emergency Room?

Jasmine C

10 Nov 2025 — 2 min read

Nurse and patient

What Did the Research Discover?

This study looked at whether a higher dose of dexamethasone (16 mg) was more effective than a lower dose (4 mg) for treating migraines in the emergency department (ED). All 209 patients in the study were given 10 mg of metoclopramide (a common migraine medication) along with either 4 mg or 16 mg of dexamethasone.

The results showed that there was no significant difference between the two doses in reducing migraine pain over 48 hours. About 34% of patients who received 4 mg and 41% of those who received 16 mg experienced sustained headache relief, but the difference was not large enough to suggest that the higher dose was more effective. Both doses also had similar effects in relieving pain within 2 hours and in reducing headache days over the following week.

Because the higher dose did not provide a clear benefit, the study was stopped early as further research was unlikely to change the results.

How Can I Apply This Information?

For patients experiencing migraines, this study suggests that a lower dose (4 mg) of dexamethasone works just as well as a higher dose (16 mg) when given with metoclopramide in the emergency room. This means that using a higher dose may not provide additional relief but could increase the risk of side effects.

For doctors and healthcare providers, these findings indicate that higher doses of dexamethasone are unlikely to be more effective for migraine treatment in the ED. Using 4 mg instead of 16 mg may be preferable, as it reduces unnecessary steroid exposure without compromising pain relief.

While corticosteroids like dexamethasone can help prevent migraines from returning, other medications—such as sumatriptan or naproxen—may be better for managing recurring headaches after discharge. More research is needed to explore alternative ways to improve long-term migraine management after an emergency visit.

Source:

Friedman BW, Solorzano C, Kessler BD, Martorello K, Lutz CL, Feliciano C, Adler N, Moss H, Cain D, Irizarry E. Randomized trial comparing low-vs high-dose IV dexamethasone for patients with moderate to severe migraine. Neurology. 2023 Oct 3;101(14):e1448-54. https://pubmed.ncbi.nlm.nih.gov/37604662/

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