Prednisone to Reduce Cluster Headaches

Written by Clay Smith

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Prednisone, given while up-titrating verapamil, was effective at reducing the frequency of cluster headache attacks.

Why does this matter?
Prednisone is often used for cluster headache, but its effectiveness hasn’t been proven in a RCT. Even one less cluster headache could impact quality of life. Does prednisone reduce cluster headache attacks?

Cluster bomb, cluster headache, cluster B…the only good cluster I know is a Goo Goo Cluster (…pecan is the best).
This was a multicenter, double blinded, placebo controlled RCT with 116 patients who received prednisone 100mg x 5 days, with a taper by 20mg every three days (17 days total) or placebo while up-titrating verapamil for prophylaxis (40mg tid up to 120mg tid over 19 days). Mean number of attacks in the first week were fewer in the prednisone group vs placebo: 7.1 vs 9.5, respectively (-2.4 headache attacks, 95%CI -4.8 to -0.03). Also, 35% of the prednisone group vs. 7% (p=0.0006) of placebo patients had complete cessation of attacks in the first 7 days. There was no increase in serious adverse events in the treatment arm. There were a number of exclusions you should be aware of and consider, such as diabetes, hypertension, gastric ulcers, along with many others. They had to stop the trial early because it was difficult to enroll patients, and they ran out of funding. Almost all patients enrolled were German, which may impact generalizability. Overall, this is an evidence based treatment that could help patients suffering with this awful condition.

Source
Safety and efficacy of prednisone versus placebo in short-term prevention of episodic cluster headache: a multicentre, double-blind, randomised controlled trial. Lancet Neurol. 2021 Jan;20(1):29-37. doi: 10.1016/S1474-4422(20)30363-X. Epub 2020 Nov 24.

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