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Study Shows Prednisone is Effective for ‘Cluster Headaches’

— December 14, 2020

New study confirmed long-held belief that prednisone is effective for treating suicide headaches.

A new multicenter, randomized, double-blind trial published in a November issue of The Lancet Neurology, has shown that the oral steroid prednisone can reduce cluster headache events, also commonly called ‘suicide headaches.’  The results indicate “patients who received the steroid had 25% fewer attacks in the first week of therapy compared to their counterparts who received placebo.”  Furthermore, “more than a third of patients in the prednisone group were pain free, and for almost half, headache frequency was reduced by at least 50% at day 7 of treatment.”

Prednisone, when used along with verapamil, “is effective in cluster headache,” said lead author Mark Obermann, MD, director, Center for Neurology, Asklepios Hospitals Seesen, and associate professor, University of Duisburg-Essen, Germany.  He added, “The key message is that all patients with cluster headache should receive prednisone at the start of an episode.”

Study Shows Prednisone is Effective for 'Cluster Headaches'
Photo by Mehrpouya H on Unsplash

Prednisone, a corticosteroid, has been widely prescribed by physicians to treat arthritis, blood disorders, breathing difficulties, allergic reactions, certain skin diseases and immune system disorders, among other ailments.  Some doctors have prescribed the medication to patients battling laryngitic as it can have an effect on vocal cords.  Cluster headaches are “unilateral attacks of facial and head pain that can last anywhere from 15 to 180 minutes,” according to researchers.

“They’re referred to as ‘suicide headaches’ because the pain is so severe that patients often report they think about killing themselves to get rid of the pain,” said Obermann. “The cause is unclear, although there’s some evidence that the hypothalamus is involved.  The headaches sometimes follow a strict circadian pattern.”  He added, “The attacks might occur over a few weeks or months and then not return for months or even years.”

“An estimated 1 in 1000 people experience cluster headache, but the condition is underrecognized, and research is scarce and poorly funded. Previous research does show that the calcium channel blocker verapamil, which is used to treat high blood pressure, is effective in cluster headache.  However, it takes about 14 days to work and has to be slowly titrated because of cardiac side effects,” said Obermann. “There’s no evidence whatsoever on what the correct dose is or whether it helps at all.  This is the gap we wanted to close.”

The study included 116 adult participants who had battled cluster headache from ten centers.  During the study, they were actively suffering from these headaches and were not taking medication.  Some patients received 100 mg oral prednisone for five days which was then reduced down to 20 mg every three days; others received a placebo.  At the same time, they an increasing dose of verapamil was administered beginning at 40 mg three times per day.

“Key secondary endpoints were reduction of attacks by more than 50% at day seven compared to baseline as well as number of patients with complete cessation of cluster headache attacks.  Quality of life, depression and safety were also assessed,” the authors found.

The authors note that oral steroids such as prednisone have been used for years for the treatment of cluster headaches without the support of substantiated evidence via research studies.  The study states, “Prednisone is commonly used for initial short-term therapy to close the gap between the first attacks and the onset of preventive medication such as verapamil.  However, this therapeutic approach was never investigated in a prospective randomized controlled trial.”


‘Clear Evidence’ Oral Steroid Effective for ‘Suicide Headache’

WebMD: Prednisone

Oral steroids for episodic cluster headache

Prednisone in Short-term Prevention of Episodic Cluster Headache (4645)

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