From the Research
Prednisone is an appropriate treatment for tractable cluster headaches, particularly as a short-term intervention during cluster periods, as evidenced by a recent study published in The Lancet Neurology in 2021 1.
Treatment Regimen
A typical regimen starts with 100 mg oral prednisone for 5 days, followed by tapering of 20 mg every 3 days, as shown in the study 1. This steroid works by reducing inflammation and suppressing the immune response, which helps interrupt the cycle of cluster headaches.
Administration and Side Effects
Patients should take prednisone with food to minimize gastrointestinal side effects and preferably in the morning to avoid sleep disturbances. Common side effects include increased appetite, fluid retention, mood changes, and elevated blood sugar.
Comprehensive Treatment Plan
It's essential to note that while prednisone can provide relief during acute clusters, it should be part of a comprehensive treatment plan that may include other preventive medications like verapamil or lithium for longer-term management, as recommended by the European Academy of Neurology guidelines in 2023 2.
Special Considerations
Patients with diabetes, hypertension, glaucoma, or peptic ulcer disease should use prednisone with caution and under close medical supervision. The use of prednisone as a bridging therapy until oral prophylactic therapy is effective is also supported by other studies, such as the one published in Drugs in 2022 3.
Key Points
- Prednisone is effective for short-term prevention of episodic cluster headaches
- Typical regimen: 100 mg oral prednisone for 5 days, followed by tapering of 20 mg every 3 days
- Common side effects: increased appetite, fluid retention, mood changes, and elevated blood sugar
- Should be part of a comprehensive treatment plan with other preventive medications
- Use with caution in patients with certain medical conditions, such as diabetes or hypertension, as advised in the study published in CNS drugs in 2020 4.