Intravenous methylprednisolone in patients with episodic cluster headache non-responders to oral steroids: results from an observational, interventional, single-center study

Background: Verapamil is the drug of choice in the prophylaxis of episodic cluster headache (ECH), and oral corticosteroids are frequently prescribed as concurrent bridging therapy. Approximately 25% of the patients do not respond to oral treatment. The aim of this study was to assess safety and efficacy of high dose intravenous methylprednisolone (MPD) in ECH patients who had not responded to combined oral therapy with prednisone and verapamil. Methods: Forty-four ECH patients – non responders to oral therapy – were treated with intravenous MPD (500 mg/day for 5 days) and verapamil during cluster headache active periods. No serious adverse event was reported. Results: After 5 days of intravenous therapy, the 24-hour frequency of cluster headache attacks significantly decreased. Sixty-eight percent of patients became headache-free, and 25% experienced a reduction of more than 50% in daily attacks. No clinical benefit was reported in the remaining three patients. Conclusions: Our study shows that intravenous MPD is a safe, effective, and reproducible treatment for ECH patients not responding to oral therapy.