Corticosteroid treatment in cluster headache: Evidence, rationale, and practice

Shapiro, Robert E.

doi:10.1007/s11916-005-0050-3

Cited by 14 publications

(11 citation statements)

References 44 publications

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“…However, these studies have nearly uniformly reported positive treatment effects, and this is consistent with the clinical experiences of most physicians caring for CH patients. [27] Caution has to be exercised in their use because of the potential for serious side-effects. Thus, a tapering course of prednisone or prednisolone for 3 weeks is prudent.…”

Section: Cluster Headachementioning

confidence: 99%

Trigeminal autonomic cephalalgias: A review of recent diagnostic, therapeutic and pathophysiological developments

Lambru

Matharu

2012

Ann Indian Acad Neurol

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The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders that are characterized by strictly unilateral trigeminal distribution pain occurring in association with ipsilateral cranial autonomic symptoms. This group includes cluster headache, paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. These disorders are very painful, often considered to be some of the most painful conditions known to mankind, and consequently are highly disabling. They are distinguished by the frequency of attacks of pain, the length of the attacks and very characteristic responses to medical therapy, such that the diagnosis can usually be made clinically, which is important because it dictates therapy. The management of TACs can be very rewarding for physicians and highly beneficial to patients.

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Section: Cluster Headachementioning

confidence: 99%

Trigeminal autonomic cephalalgias: A review of recent diagnostic, therapeutic and pathophysiological developments

Lambru

Matharu

2012

Ann Indian Acad Neurol

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“…Moreover, there are no double-blind placebo-controlled studies of corticosteroid efficacy: nonetheless, corticosteroids have been used for rapid CH control for more than 60 years Horton (1952). Oral and intravenous corticosteroids may be beneficial Ashkenazi & Schwedt (2011); Shapiro (2005). For oral administration, daily 40–80 mg prednisolone with gradual reduction over 10 days or longer is recommended Couch & Ziegler (1978).…”

Section: Discussionmentioning

confidence: 99%

High-dose intravenous methylprednisolone for the prophylactic treatment of cluster headache

et al. 2013

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BackgroundTriptans are effective for immediate relief of episodic cluster headache (CH) but do not reduce the frequency of attacks. Intravenous bolus injection of corticosteroids like methylprednisolone (MP) has been reported to decrease the frequency of CH attacks. We validated the prophylactic efficacy of MP pulse therapy by monitoring CH recurrence over several years following treatment of six consecutive male patients (mean age: 38.8 years, range: 26–54 years) afflicted by frequent (often daily) CH attacks.FindingsTotal MP dose per infusion was 250–500 mg for five patients and 125 mg for the sixth (a diabetic). High-dose MP was administered for 2 or 3 consecutive days in hospital for the first two patients treated. The next four patients received a single bolus injection at presentation, and in some cases a second injection days later at an outpatient clinic. The first two cases treated were also prescribed daily oral prednisolone for at most 6 months while the latter four cases were not. The frequency of CH attacks was markedly reduced in all patients, with intervals between attacks ranging from 4 to 23 months. We noted no apparent adverse events following MP administration.ConclusionsHigh-dose MP therapy reduced CH attack frequency and improved patient quality of life.

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“…I know the recently published European guidelines for CH treatment recommend the use of steroids, but I like to stay away from them even short term [28••]. I'm probably one of the few who rarely uses steroids for cluster headache, even for short-term or bridging therapy, even though it's clear they are effective [29].…”

Section: Response To Vignette 5 a Patient With Intractable Ch Dependmentioning

confidence: 99%

Cluster headache treatment dilemmas: The experts respond

Loder

Rizzoli²,

McGeeney³

et al. 2007

Curr Pain Headache Rep

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When conventional treatment approaches to cluster headache are unsuccessful, expert recommendations are relevant but may not be easily accessible to treating clinicians. We conducted a study of expert recommendations in response to standardized vignettes. Ten expert headache clinicians were asked what treatment they would recommend for a hypothetical 55-year-old male cluster headache patient in the following five situations: 1) known coronary artery disease with response only to sumatriptan; 2) strictly unilateral headaches unresponsive to preventive treatment; 3) effective abortive treatment not covered by insurance; 4) patient request to obtain methysergide from Canada; and 5) headaches responsive only to steroid treatment.

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Corticosteroid treatment in cluster headache: Evidence, rationale, and practice

Cited by 14 publications

References 44 publications

Trigeminal autonomic cephalalgias: A review of recent diagnostic, therapeutic and pathophysiological developments

Trigeminal autonomic cephalalgias: A review of recent diagnostic, therapeutic and pathophysiological developments

High-dose intravenous methylprednisolone for the prophylactic treatment of cluster headache

Cluster headache treatment dilemmas: The experts respond

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