Steroids and aseptic osteonecrosis (AON) in migraine patients

Osteonecrosis is a bony infarction caused by disruption of blood supply to the bone. Aseptic osteonecrosis should be rare with intermittent use of steroids in disabling and refractory migraine cases. We present 3 cases of patients who had severe migraine and developed aseptic osteonecrosis with short-term, intermittent pulse doses of corticosteroids. Migraine has been mentioned as a possible risk factor for aseptic osteonecrosis, and we speculate that severe migraine may be a risk factor for developing aseptic osteonecrosis. Furthermore, migraineurs who develop aseptic osteonecrosis may or may not have associated white matter changes in the brain. We noted a triad of severe migraine, osteonecrosis, and migraine-related white matter lesions in only 1 case. In severe cases of migraine, steroids should be used cautiously.