Oral Steroids Perform Better Than Injection in Short-Term Cluster Headache Management

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The most common starting dose for oral steroid taper was prednisone 60 mg.
The most common starting dose for oral steroid taper was prednisone 60 mg.

According to a retrospective study published in Headache, oral steroids may be more effective than greater occipital nerve injections for short-term prophylaxis of cluster headache.

During cluster headache episodes, transitional therapies are often administered while long-term prophylactic medications are being titrated. Data are limited about the efficacy of oral vs injected steroids.

Investigators reviewed the medical charts of patients seen at the Montefiore Headache Center. Diagnosis of cluster headache had been made using the International Classification of Headache Disorders, 3rd edition beta criteria.

Transitional therapy was analyzed and categorized as providing complete, partial, or no response. Complete response to therapy was defined as termination of headache episodes by 1 week of treatment. Partial response was defined as a reduction in frequency of episodes by 1 week of treatment or return of headache episodes even after initial cessation. No response was defined as either no change or worsening of headache episodes.

Forty-three patients were included in the analysis. A total of 140 transitional therapy encounters were analyzed. Oral steroids were administrated in 81 of these encounters, and greater occipital nerve injections were administered in 59 of these encounters. Of the study cohort, 24 patients received only one type of treatment and 16 patients received both options.

A higher percentage of encounters in which oral steroids were administered vs greater occipital nerve injections resulted in a partial (82.7% vs 64.4%) or complete response (50.6% vs 35.6%).

Of the 16 patients receiving both treatments, 50% responded to both options, 37.5% responded to oral steroids only, and 6.3% responded to greater occipital nerve injections only.

No adverse effects were documented from either treatment.

“Ideally, a future study addressing transitional therapy for [cluster headache] would be a prospective, randomized, placebo/sham controlled clinical trial to better ascertain the optimal dosage and length of treatment for oral prednisone compared to [greater occipital nerve] steroid injection for transitional treatment of [cluster headache], “ the authors wrote. “In the absence of these data, however, our study suggests both oral and [greater occipital nerve] injected steroids may both be effective as transitional therapy of [cluster headache], with oral steroids potentially more beneficial.”

Reference

Wei J, Robbins MS. Greater occipital nerve injection versus oral steroids for short term prophylaxis of cluster headache: a retrospective comparative study [published online May 21, 2018]. Headache. doi: 10.1111/head.13334

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