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Most people who live with migraine rely on medications approved specifically for migraine attacks. These may include drugs taken at the first sign of symptoms or preventive treatments used regularly.
When migraine attacks last several days or keep returning, doctors may use other medications to break the migraine cycle. These prolonged migraine attacks or chronic migraine symptoms may not respond to standard migraine treatment.
One option is prednisone, a prescription corticosteroid medication. Prednisone isn’t a standard migraine treatment, but it may play a role in certain situations when migraines become prolonged or difficult to treat.
Understanding how prednisone works and when it may be prescribed can help you have more informed conversations with your healthcare provider. In this article, we discuss the use of steroids in migraine treatment.
Prednisone is a corticosteroid, a type of medicine that reduces inflammation in the body and suppresses immune system activity. It’s been used for decades to treat many inflammatory and immune-related conditions.
Doctors commonly prescribe prednisone for conditions such as:
Prednisone works by calming inflammation throughout the body. Because inflammation is involved in many medical conditions, corticosteroids can help relieve symptoms quickly in some situations.
However, prednisone is generally used for short periods of time when possible. Long-term or frequent use can lead to serious side effects.
Prednisone isn’t a routine migraine medication. Most migraine care focuses on treatments specifically designed for migraine attacks, such as nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, calcitonin gene-related peptide (CGRP)-targeting medications, or other acute treatments.
Instead of being a first-line option, prednisone may be used as a short-term, backup strategy for prolonged or difficult-to-treat migraine. Doctors may prescribe prednisone when a migraine lasts much longer than usual or when other treatments haven’t worked.
In these cases, prednisone may help interrupt a prolonged migraine cycle.
Although practices vary among clinicians, prednisone may be prescribed in a few specific migraine scenarios.
One of the most common reasons doctors use prednisone is status migrainosus, an intractable migraine attack that lasts longer than 72 hours.
“I went on a steroid pack to break my migraine cycle before starting CGRP medications,” said one member of MyMigraineTeam. “The steroids really helped break the cycle to give the other meds a chance to kick in.”
Another member said, “My neurologist finally put me on a steroid, after deciding I need something stronger for my ‘status migrainosus’ that started nine days ago.”
Status migrainosus can be extremely debilitating. Symptoms may include:
Standard migraine medications may not always stop the attack.
In these situations, doctors may prescribe a short course of corticosteroids like prednisone to help break the migraine cycle.
Some types of migraine may not meet the formal definition of status migrainosus but still last several days or recur frequently.
For example, someone might experience:
In these cases, prednisone may be used as a short-term intervention to help calm the underlying process keeping the migraine active.
“I went to the neuro doctor on the fifth day of my migraine, and he gave me a shot of Toradol and a steroid, then put me on a prednisone taper pack,” said a MyMigraineTeam member. “I didn’t have a headache for five days but woke up with one again on the sixth day.”
Some people visit the emergency department for severe migraine attacks that don’t respond to home treatments.
In the hospital, doctors may use what’s often called a “migraine cocktail.” These combinations of medications can include drugs for pain, nausea, and inflammation.
Even after symptoms improve, the headache can sometimes return within a day or two. To help prevent this, some clinicians prescribe a short course of prednisone after emergency treatment. However, this approach hasn’t been found to be effective in some research.
The goal is to reduce the chance that the migraine attack will rebound.
Researchers are still studying exactly how corticosteroids affect migraine.
One theory is that prolonged migraine attacks involve ongoing inflammation in the nervous system, particularly around the trigeminal nerve and related pathways involved in migraine pain.
Prednisone may help by:
Corticosteroids may help reduce inflammation that keeps a migraine going, potentially shortening prolonged attacks.
However, clinical studies provide mixed evidence for effectiveness. Prednisone is generally reserved for specific, difficult cases. As a result, practices may differ from doctor to doctor.
When prednisone is used for migraine, it’s typically prescribed as a short course, sometimes called a “burst” or taper, which means gradually lowering the dose.
A short course may last a few days, up to one week. Some regimens start with a higher dose of medication and gradually taper it over several days to reduce side effects. Others may involve a brief fixed course.
The exact plan depends on your doctor’s clinical judgment and your individual health situation. Because prednisone affects many systems in the body and can cause serious side effects, it should be taken exactly as prescribed.
Although prednisone can help in certain situations, it’s not meant to be used frequently for migraine attacks.
Repeated or long-term corticosteroid use can cause a range of side effects and health risks. Because of this, doctors usually reserve prednisone for occasional use when other treatments haven’t worked.
Migraine specialists typically focus on treatments designed specifically for migraine, including:
If your migraine attacks are frequent, your doctor may help you explore preventive treatment options.
Like all medications, prednisone can cause side effects. Short courses are generally well tolerated, but some people may still experience temporary symptoms.
Possible short-term side effects include:
These effects usually go away after the medication is stopped.
More serious side effects are more likely with long-term or repeated steroid use, which is another reason doctors try to limit how often prednisone is prescribed.
Using prednisone repeatedly or for long periods can lead to more significant health issues.
Potential long-term risks include:
Because of these risks, doctors generally avoid using steroids regularly for migraine management. If your current therapy isn’t working well, it may help to review your options with your healthcare provider.
If you’ve experienced a migraine attacks that lasts several days or keeps returning after treatment, it may be worth discussing additional options with your doctor.
Questions you might ask include:
Preparing questions ahead of time can make migraine appointments more productive. Together, you can review your treatment plan and explore strategies that may help you gain better control over migraine symptoms.
On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.
Have you ever been prescribed prednisone for migraine headaches? Let others know in a comment below.
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