Do you typically give GI prophylaxis when providing patients with steroid taper for status migrainosus?

I usually do a 3-6 day taper with prednisone, dexamethasone, or medrol dose pack for status migrainous. Occasionally, I have done a 12-day taper if the status migrainous is prolonged. I have not used GI prophylaxis.

The corticosteroid taper I typically employ for status migrainosus is a three-day course of prednisone: 15 mg qid x 1 day, 10 mg qid x1 day, and 5 mg qid x 1 day. I have patients take it with meals and at bedtime with a snack to protect the stomach. Such a short course is usually tolerated well without stomach issues. It is, of course, a small effort to combine it with a PPI, such as omeprazole 20 mg qd. However, I would probably only do that if indicated.

Typically speaking, unless there's a clear indication otherwise, a 1-2 week taper (60 mg to 0 mg, whether you prefer using 10 mg or 20 mg increments) does not need a GI prophylaxis regimen.

It is helpful to notify patients that steroids for a short time like this are usually well tolerated, with minimal side effects by most patients, but side effects can include nausea (not all patients), irritability (usually none/minimal/mild, typically only at the start), troubles sleeping, tachycardia (incr...

I usually use prednisone 20 mg tablets:

3 tablets for 3 days

2 tablets for 3 days

1 tablet for 3 days

This should be taken with food and breakfast since steroids sometimes make people hyper.

I found that one medrol dose pack sometimes does not work, especially for patients with severe migraine, and they may need a double dose, like 6 tablets for 2 days, 5 tablets for 2 days, etc.

Usually, the patient knows if they need stomach protection or not, and they can take OTC pepcid for that.