Do you ever utilize a steroid pulse in patients who are pregnant with status migrainosus?

According to ACOG, if steroids are use oral prednisone 20mg po QID x2d or methylprednisone dosepak is preferred over dexamethasone due to lower fetal exposure. Dexamethasone could be considered even parenterally if these do not work and attack is particularly refractory. However, they recommend that use be done cautious, and note that first trimester exposure has a risk of oral clefting.

Personally I avoid steroids in pregnancy when possible. In status migrainosus, my first choices would lidoca...

For migraine status, I prescribe prednisone 15 qid x 1 day, 10 mg qid x 1 day, and 5 mg qid x 1 day. I may combine it with diazepam 1-5 mg qid with prominently associated muscle tightness in the neck, shoulders, and jaws. Very importantly, with the start of the regimen, all abortive medications should be discontinued, including those obtained over the counter.