Prophylactic treatment of episodic cluster headache with intravenous bolus of methylprednisolone

Abstract

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.

Endocrinology of cluster headache: Potential for therapeutic manipulation

“…Corticosteroids have been empirically used in a variety of regimens to treat recurrences of CH periods since the 1970s [39][40][41][42][43][44][45]. There are no double-blinded or controlled published studies, except for the greater occipital nerve study by Ambrosini et al [44].…”

“…One other approach uses intravenous methylprednisolone, 250 g/day for 3 days, followed by oral prednisone, 90 mg/ day tapered over 4 weeks [39,42]. In an open-label study that used this regimen, one third of patients achieved "immediate and complete" remission.…”

Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion: A preliminary study of 23 patients

“…A variety of treatments have been investigated for prevention or symptoms relief in these patients, including triptans (22,23), ergotamine (24), topiramate (8), hyperbaric oxygen therapy (25), and oral or parenteral corticosteroids (10,26,27). Surgery must be viewed with great caution, since there are no reliable long-term data on the results obtained.…”

Recommandations pour le diagnostic et le traitement de l’algie vasculaire de la face

“…Après l'étude ouverte de Mir en 2003 [84] utilisant en ouvert des bolus intraveineux de méthylprednisolone, Antonaci en 2005 [85] a traité 13 patients au 8 e jour de leur période douloureuse par un bolus de methylprednisolone à 30 mg/kg (grade C). Cette étude ouverte a montré une efficacité des bolus IV de corticoïdes, mais a priori sans supériorité par rapport à la prednisolone par voie orale.…”