Steroid Injections for Cluster Headache?
Hello. My name is Christoph Diener. I am a neurologist from the University of Essen in Germany. Today's topic is cluster headaches.
You all know that the treatment of cluster headaches is very difficult. Some patients have very frequent attacks of cluster headaches, and preventive therapies, such as verapamil, lithium, or topiramate, may take up to 8 weeks until they begin to work. We definitely need something that works more quickly but is not for long-term use.
The October issue of Lancet Neurology included a very interesting study performed in the Headache Emergency Center [at the Lariboisière Hospital] in Paris, France. Investigators recruited patients who had at least 2 cluster attacks per day and randomly assigned patients to receive 3 suboccipital injections of either corticosteroids or saline, ipsilateral to the headache, within 72 hours. All patients were already receiving treatment with verapamil.
The primary endpoint was the reduction of cluster attacks to 2 or fewer per day within the next 2-4 days. The investigators recruited 43 patients, 15 with chronic cluster headaches and 28 with episodic cluster headaches. The primary endpoint was achieved by 20 of the 21 patients in the active treatment group and 12 of 21 patients in the placebo group. I think this shows that this treatment is highly effective and the differences were significant.
Within the next 15 days, patients in the active treatment group only had 10 attacks of cluster headaches, compared with 30 attacks of cluster headaches in the placebo group. There were no major adverse events. The only complaint in the treatment group was occasional injection site neck pain.
This study shows that a local injection of corticosteroid into the greater occipital nerve ipsilateral to the pain in cluster headache can improve the condition for the subsequent 2 weeks. In this way, we could help patients until our prophylactic medications start to work.
Hello. My name is Christoph Diener. I am a neurologist from the University of Essen in Germany. Today's topic is cluster headaches.
You all know that the treatment of cluster headaches is very difficult. Some patients have very frequent attacks of cluster headaches, and preventive therapies, such as verapamil, lithium, or topiramate, may take up to 8 weeks until they begin to work. We definitely need something that works more quickly but is not for long-term use.
The October issue of Lancet Neurology included a very interesting study performed in the Headache Emergency Center [at the Lariboisière Hospital] in Paris, France. Investigators recruited patients who had at least 2 cluster attacks per day and randomly assigned patients to receive 3 suboccipital injections of either corticosteroids or saline, ipsilateral to the headache, within 72 hours. All patients were already receiving treatment with verapamil.
The primary endpoint was the reduction of cluster attacks to 2 or fewer per day within the next 2-4 days. The investigators recruited 43 patients, 15 with chronic cluster headaches and 28 with episodic cluster headaches. The primary endpoint was achieved by 20 of the 21 patients in the active treatment group and 12 of 21 patients in the placebo group. I think this shows that this treatment is highly effective and the differences were significant.
Within the next 15 days, patients in the active treatment group only had 10 attacks of cluster headaches, compared with 30 attacks of cluster headaches in the placebo group. There were no major adverse events. The only complaint in the treatment group was occasional injection site neck pain.
This study shows that a local injection of corticosteroid into the greater occipital nerve ipsilateral to the pain in cluster headache can improve the condition for the subsequent 2 weeks. In this way, we could help patients until our prophylactic medications start to work.
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