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
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
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
