Prednisone effective preventive therapy for episodic cluster headaches: Lancet

Germany: A recent study has supported the use of oral prednisone as a first-line treatment for patients with episodic cluster headaches, in parallel to the up-titration of verapamil. According to the study, published in the journal Lancet Neurology, prednisone is an effective short-term preventive therapy.

Prednisone is used commonly for initial short-term therapy of episodic cluster headaches before preventive medication such as verapamil becomes effective.It is thought that these potent medications help in two ways. Firstly, steroids may reduce the release of chemicals in the body that cause inflammation and pain. Secondly, the they may suppress the immune system which helps reduce inflammation and the associated pain.

However, this strategy has not been tested in large randomized trials. Prof Mark Obermann, Asklepios Hospitals Schildautal, Seesen, Germany, and colleagues aimed to access the safety and efficacy of this treatment approach.

The study was performed in 10 specialized centres in Germany. It included patients with episodic cluster headaches (aged between 18 and 65 years) and within a current pain episode for not more than 30 days, received 100 mg oral prednisone for 5 days followed by tapering of 20 mg every 3 days, or matching placebo (17 days total exposure). All the patients had received oral verapamil for long-term prevention. Oral verapamil was started with 40 mg three times daily and increased to 120 mg three times daily by day 19. Then patients were continued with verapamil 120 mg throughout the study.