Using Steroids to Treat Cluster Headache
Pain. 2005 Nov;118(1-2):92-6. Epub 2005 Oct 3.
Suboccipital injection with a mixture of rapid- and long-acting steroids in
cluster headache: a double-blind placebo-controlled study.
Ambrosini A, Vandenheede M, Rossi P, Aloj F, Sauli E, Pierelli F, Schoenen J.
Headache Clinic, INM Neuromed, IRCCS, Via Atinense, 18, I-86077 Pozzilli,
Isernia, Italy. anna.ambrosini@neuromed.it
Oral steroids can interrupt bouts of cluster headache (CH) attacks, but
recurrence is frequent and may lead to steroid-dependency. Suboccipital steroid
injection may be an effective 'single shot' alternative, but no
placebo-controlled trial is available. The aim of our study was to assess in a
double-blind placebo-controlled trial the preventative effect on CH attacks of
an ipsilateral steroid injection in the region of the greater occipital nerve.
Sixteen episodic (ECH) and seven chronic (CCH) CH outpatients were included. ECH
patients were in a new bout since no more than 1 week. After a one-week run-in
period, patients were allocated by randomization to the placebo or verum arms
and received on the side of attacks a suboccipital injection of a mixture of
long- and rapid-acting betamethasone (n=13; Verum-group) or physiological saline
(n=10; Plac-group). Acute treatment was allowed at any time, additional
preventative therapy if attacks persisted after 1 week. Three investigators
performed the injections, while four others, blinded to group allocation,
followed the patients. Follow-up visits were after 1 and 4 weeks, whereafter
patients were followed routinely. Eleven Verum-group patients (3 CCH) (85%)
became attack-free in the first week after the injection compared to none in the
Plac-group (P=0.0001). Among them eight remained attack-free for 4 weeks
(P=0.0026). Remission lasted between 4 and 26 months in five patients. A single
suboccipital steroid injection completely suppresses attacks in more than 80% of
CH patients. This effect is maintained for at least 4 weeks in the majority of
them.
PMID: 16202532
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Cephalalgia. 2005 Apr;25(4):290-5.
Single high-dose steroid treatment in episodic cluster headache.
Antonaci F, Costa A, Candeloro E, Sjaastad O, Nappi G.
Department of Neurological Sciences, IRCCS C. Mondino, University of Pavia, 27100 Pavia, Italy. neuronet@libero.it
Corticosteroids appear to be the most rapid-acting of the prophylactic drugs used in the treatment of cluster headache (CH). These agents are frequently employed as a short-term regimen to induce clinical remission. In this study, we assessed in an open fashion the effect of high dose methylprednisolone (MPD) in a group of 13 patients with episodic CH (3 females and 10 males). On the 8th day of the active period, MPD was administered intravenously at the dose of 30 mg/kg body weight, as a 3-h infusion in saline. The attack frequency was followed for 7 days. The mean daily attack frequency before MPD administration was statistically different from that reported after treatment (respectively: 1.38 +/- 0.42 and 0.83 +/- 0.78; P = 0.05 Student's t-test). The mean interval between MPD administration and the occurrence of the first subsequent attack was 3.8 +/- 2.2 days (range: 2-7 days). Only 3 (23%) of 13 patients experienced a complete headache remission. No significant side-effects were noted after MPD administration. These data further demonstrate that in most patients with episodic CH, high-dose systemic steroid administration may invariably interrupt attack recurrence for a few days, but is ineffective in maintaining complete clinical remission. This study also suggests that MPD administered as a solitary dose does not provide any advantage above prednisone in CH treatment.
PMID: 15773826
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Neurol Sci. 2003 Dec;24(5):318-21.
Prophylactic treatment of episodic cluster headache with intravenous bolus of methylprednisolone.
Mir P, Alberca R, Navarro A, Montes E, Martínez E, Franco E, Cayuela A, Lozano P.
Department of Neurology, University Hospital Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain.
We evaluated the efficacy of intravenous boluses of methylprednisolone followed by prednisone as a prophylactic treatment for episodic cluster headache. Fourteen male patients (mean age, 42.54 years) with episodic cluster headache were treated with 250-mg boluses of methylprednisolone on 3 consecutive days, followed by prednisone (90 mg/day orally) with gradual tapering in four weeks. Headache parameters of the active phases treated with methylprednisolone were compared with those of previous active phases in the same patients treated with other prophylactic medications. The primary efficacy criterion was decrease in the frequency of attacks during the first month of treatment. The statistical differences were calculated using Wilcoxon's test. The attacks were significantly less frequent in the active phases treated with methylprednisolone boluses than those treated with other medications ( p<0.05). This treatment seems to be more effective than the usual prophylactic treatments for episodic cluster headache.
PMID: 14716526
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