Eight RCTs (903 patients) were included in the review. Seven trials achieved the maximum score of 5 on the Jadad scale and one scored 4 points. Follow-up was between 24 and 72 hours.
Pooled analysis showed when steroids were added to standard abortive therapy they reduced the rate of moderate or severe headache recurrence after 24 to 72 hours compared to placebo (RR 0.71, 95% CI 0.59 to 0.86; eight trials; NNT=10). There was no evidence of publication bias. There was no significant benefit in the proportion of totally resolved migraines (RR 1.11, 95% CI 0.94 to 1.32; six trials).
Six trials reported specific adverse events. Patients treated with steroids were more likely to have dizziness (RR 2.78, 95% CI 1.02 to 7.61; four trials). No significant differences were found between steroids and placebo groups for restlessness, drowsiness, nausea or vomiting, tingling, numbness, swelling and any other adverse events. Results of subgroup and sensitivity analyses were presented.