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

Abstract

The use of corticosteroids in the treatment of cluster headache (CH) is commonplace and has been a mainstay of clinical practice for this indication for 50 years. The published evidence supporting this practice is weak, with no methodologically rigorous or large-scale controlled trials executed. Nonetheless, the clinical experiences of practitioners and the conclusion of investigators provide a clear signal of benefit from corticosteroid use in CH. The pathophysiologic explanation for this beneficial effect is unknown, but corticosteroid influences on inflammatory, hypothalamic-pituitary-adrenal, histaminergic, and opioid systems have been proposed. Best-practice parameters are unclear, but the professional consensus is that corticosteroids generally are effective for arresting CH attacks, only if administered in relatively high doses, and that safety concerns warrant courses of 4 weeks or less. Concomitant use of other prophylactic agents for CH in addition to corticosteroids usually is advisable because attacks often recur when the corticosteroid dose is tapered.

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

“…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.…”

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

“…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).…”

Cluster headache treatment dilemmas: The experts respond

“…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].…”