Is prednisone good for migraines?

In this article:

• Prednisone for migraines
• How does it work
• How long does it take to work
• Dosage for migraines
• Alternatives
• The bottom line

In this article

• Prednisone for migraines
• How does it work
• How long does it take to work
• Dosage for migraines
• Alternatives
• The bottom line

Prednisone (and dexamethasone) are corticosteroids that treat conditions such as allergies, inflammation, asthma, and much more. They’re prescription drugs that work by reducing swelling and symptoms caused by immune system reactions. 

Since inflammation can also contribute to episodic migraines, and the treatment of acute migraines often entails anti-inflammatory drugs, could prednisone be used to treat cephalgia (or head pain), too?

Healthcare professionals don’t typically prescribe prednisone for the 39 million Americans who get migraine attacks, but they will in some situations.

Can prednisone be used for migraines?

Usually, other medications are used for migraine treatment. “Current practice recommendations do not recommend the routine use of prednisone, a corticosteroid, in the acute treatment of migraines,” says Dr. Luke Hentrich, Pharm.D., BCPS, an assistant professor who answered the questions in conjunction with Hannah Suber, a Pharm.D. candidate, both at the University of Tennessee’s Health Science Center College of Pharmacy. 

However, prednisone is sometimes used to treat migraines. Dr. Hentrich says the body of literature for using corticosteroids to treat migraines has been found to be beneficial in treating “status migrainosus,” or over-seven-day-long “severe migraines that persist despite the appropriate use of over-the-counter and prescription medications, and those who have a history of recurrent migraine headaches.”

It can be taken alone or in conjunction with another medication. “Prednisone is quite efficient by itself or as adjunct to other migraine medication in treating recurring moderate to severe migraines called status migrainosus, and also certain types of headaches,” agrees Dr. Hany Demian, MD, a pain management healthcare provider and CEO of BioSpine Institute. 

A 2019 article in Evidence-Based Practice suggests this, too. It says adding a steroid to standard abortive therapy reduced the rate of moderate or severe recurrence of migraines within 72 hours of treatment by about 30% compared to the placebo group.

The way a patient consumes the steroid may also matter. A 2018 retrospective study in Headache: The Journal of Head and Face Pain found that both oral steroids and intravenous injection steroids can serve as a short-term treatment for cluster headaches, but the former might be more effective. The researchers noted that a randomized trial is a warranted next step, though.

Another option for treating cluster headaches is dihydroergotamine, an acute migraine medication. Why might one medication be prescribed over another? 

Dr. Hentrich says healthcare providers prescribe prednisone “if a patient is unable to take common medications prescribed for acute migraine treatment.” He gives the examples of a person with a kidney condition being unable to take ibuprofen, or sumatriptan due to a previous heart attack, or rimegepant due to insurance coverage. 

“They may also prescribe prednisone if the migraine has persisted for a long period, or for migraines that persist from overuse of other acute treatments, known as medication overuse headache,” Dr. Hentrich adds.

According to Dr. Demian, triptans are most often prescribed to kill migraine headaches, and they’re taken as soon as the migraine begins. He adds that nasal sprays are faster-acting triptans.

The former is true in Dr. Hentrich’s practice; he specifies that sumatriptan (as an oral tablet, nasal spray, nasal powder, or subcutaneous injection) is most commonly prescribed—but again, that option can be dangerous for people who have had a heart attack.

As far as prophylactic measures or migraine prevention, Botox is a common go-to, Dr. Demian says.

How does prednisone work for migraines?

Since prednisone isn’t currently recommended outright, the mechanisms behind its helpfulness for migraines are unclear, according to Dr. Hentrich. But, according to him and Dr. Demian, the reasoning probably goes back to inflammation.

“Prednisone or corticosteroids can readily cross the blood-brain barrier and reduce neurogenic inflammation, hence reducing the recurrence of headaches,” Dr. Demian explains.

How long does it take prednisone to work for migraines?

While there’s no definitive evidence around how quickly a person may feel prednisone’s benefits during a migraine, Dr. Hentrich says available pharmacokinetic information suggests around two hours.

According to Dr. Demian, it can be as long as four hours (on average), though. The length of time depends on various factors, he continues, such as other medications consumed, whether the diagnosis is accurate, and the differentiation between different types of headaches. 

Further, how well the body digests and metabolizes the medicine varies from person to person. “Some conditions may lead to inadequate absorption of prednisone, including kidney and liver impairment and inflammatory bowel disease,” Dr. Hentrich says.

Prednisone dosage for migraines

The general prednisone dosage for adults is 5 mg to 60 mg per day. A high dose may be needed for migraines, though.

A 2020 study in Neurology gave cluster headache participants 100 mg of oral prednisone for five days, then tapered by 20 mg every three days, or a placebo with an increasing dose of verapamil, starting with 40 mg three times per day. Almost 50% of the participants who took prednisone experienced a headache attack reduction, whereas only 14.5% of those who took the placebo reported the same.

Another study by Cephalalgia stopped symptomatic medications and started prednisone in tapering doses for 6 days, then introduced preventive medication. It was also successful because 85% of the participants had less frequent headaches during the first six days. 

Pretty promising research, right?

Prednisone is best taken with food or milk in the morning, and the latter is used to align with the body’s corticosteroid production. To avoid misuse, follow a healthcare provider’s instructions on how much to take and how often. Prednisone dependence is unusual, thankfully, though it can be serious.

Comparing prednisone with other migraine medications

Is one medication for migraines better than another? Dr. Hentrich says no large studies have compared prednisone to other medications for acute migraine treatment, though a small study has. 

The small study, published in Headache: The Journal of Head and Face Pain, compared prednisone to celecoxib, a prescription nonsteroidal anti-inflammatory drug (NSAID) and analgesic. The results showed that celecoxib was favored during the first three weeks and had fewer adverse effects than prednisone.

Prescription triptans and CGRP antagonists are efficacious, too. “However, some triptans, such as intranasal and subcutaneous sumatriptan, may work more quickly than others,” Dr. Hentrich adds. “CGRP antagonists, such as ubrogepant and rimegepant, are newer agents that are highly effective for acute migraine treatment and have a favorable side effect profile.”

As Dr. Demian mentioned, Botox is considered the gold standard, but only as a preventive treatment. Otherwise, he doesn’t see a clear winner. “Prednisone is an effective drug, but as effective as the new generation of triptans,” he says.

The “best” treatment depends on an individual’s health history. 

According to Dr. Hentrich, jumping straight to prescription medications might not be the answer. He recommends starting with NSAIDs and combination acetaminophen products first—and fast. “Taking medications for the acute treatment of migraines at the first sign of a migraine is vitally important for stopping the migraine from progressing,” he says, noting the first sign of a migraine is an aura, or visual symptoms, for many people.

More natural migraine treatments—specifically, ones that can reduce frequency and intensity—include vitamins and supplements, such as magnesium, riboflavin, feverfew, and butterbur.

The bottom line

• While prednisone is sometimes prescribed for headaches and migraines—and may be helpful for patients who can’t take other medications—it’s not generally recommended or the main go-to.
• This information is not a substitute for medical attention. Consulting with a neurologist or other healthcare provider for outpatient treatment is vital. Those providers can provide an individualized treatment plan.
• If the headache attack reaches a new level of pain, causes new symptoms, such as trouble speaking or vision changes, or accompanies any exacerbations or other adverse events, visit the emergency department and schedule a follow-up appointment.
• You can save money on purchasing prednisone with a SingleCare prescription discount card.