Patients with CH often require a multimodal treatment approach during cluster periods using acute, transitional, and prophylactic therapy. Transitional therapies are useful in treating high frequency cluster headache attacks while prophylactic medication dosages are increased. However, there is limited data comparing the efficacy of oral versus injected transitional treatments.
Triptans are effective for immediate relief of episodic cluster headache (CH) but do not reduce the frequency of attacks. Intravenous bolus injection of corticosteroids like methylprednisolone (MP) has been reported to decrease the frequency of CH attacks. We validated the prophylactic efficacy of MP pulse therapy by monitoring CH recurrence over several years following treatment of six consecutive male patients (mean age: 38.8 years, range: 26–54 years) afflicted by frequent (often daily) CH attacks.
Bouts of cluster headache may be resistant to all the drugs usually effective, such as typical migraine preventing drugs, lithium, carbamazepine, valproate, and corticosteroids. Corticosteroids have been commonly used in cycles of 10–15 intravenous daily infusions of 50–100 mg prednisone. During a severe bout in a patient resistant to all treatments, we have tried high dose (500 to 1000 mg/day intravenously) methylprednisolone administration: single doses were found to be effective in blocking headache attacks for several days.