Abstract
BackgroundTriptans 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.FindingsTotal MP dose per infusion was 250–500 mg for five patients and 125 mg for the sixth (a diabetic). High-dose MP was administered for 2 or 3 consecutive days in hospital for the first two patients treated. The next four patients received a single bolus injection at presentation, and in some cases a second injection days later at an outpatient clinic. The first two cases treated were also prescribed daily oral prednisolone for at most 6 months while the latter four cases were not. The frequency of CH attacks was markedly reduced in all patients, with intervals between attacks ranging from 4 to 23 months. We noted no apparent adverse events following MP administration.ConclusionsHigh-dose MP therapy reduced CH attack frequency and improved patient quality of life.
Highlights
Subcutaneous injection of sumatriptan succinate is an effective treatment for the immediate relief of episodic cluster headache (CH) but does not reduce the frequency of future attacks
We evaluated the efficacy of this treatment for Japanese male patients experiencing frequent CH attacks
The MP pulse therapy regimens used on initial presentation, the times of recurrence, and oral prednisolone regimens are presented in Table
Summary
Subcutaneous injection of sumatriptan succinate is an effective treatment for the immediate relief of episodic cluster headache (CH) but does not reduce the frequency of future attacks. Prolonged or frequent attacks and associated treatment visits can greatly impair patient quality of life. In Japan, self-administration of sumatriptan succinate was approved in February 2008, and this change has greatly reduced emergency visits and hospital admissions due to CH. Triptans are effective for immediate relief of episodic cluster headache (CH) but do not reduce the frequency of 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.
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