Short-term prednisone reduces episodic cluster headache attacks

  • Lancet Neurol

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Oral prednisone is associated with a significant decrease in frequency of episodic cluster headaches compared with placebo, with a similar rate of adverse events (AEs).
  • This study examined an initial dose of 100 mg for the first 5 days, followed by tapering by 20 mg every 3 days.

Why this matters

  • Current guidelines recommend corticosteroids to prevent episodic cluster headaches until longer-acting preventive medications can take effect.
  • A lack of consensus on dosage and concerns about AEs have contributed to limited use by pain specialists.

Study design

  • Multicenter, randomized, double-blind, placebo-controlled trial.
  • 116 patients with episodic cluster headache received prednisone (n=57) or placebo (n=59).
  • Funding: German Federal Ministry for Education and Research.

Key results

  • Prednisone group had fewer headache attacks:
    • Within the first week: 7.1 vs 9.5 attacks. 
      • Mean difference: −2.4 (P=.002).
    • After 28 days: 15.6 vs 20.2 attacks.
      • Mean difference: −4.7 (P=.0356).
  • Number of headache days was significantly lower with prednisone from baseline to 7 days: 3.9 vs 5.1 days (P=.0141).
  • Attacks ceased after 7 days in 35% of prednisone group vs 7% with placebo.
  • Prednisone group needed fewer doses of rescue medication at 7 days (6.0 vs 9.2; P=.0012) and 28 days (12.2 vs 17.1; P=.0373).
  • AE frequency and severity were similar between groups.

Limitations

  • Study halted prematurely because of recruitment and funding shortages.