Suboccipital steroid injections for cluster headache

January 01, 0001

Suboccipital steroid injections for cluster headache

Suboccipital steroid injections can be used for preventive treatment of cluster headache but few data are available for the efficacy of this approach in clinical trials. The researchers from France and Canada aimed to assess efficacy and safety of repeated suboccipital injections with cortivazol compared with placebo as add-on therapy in patients having frequent daily attacks. In this randomised, double-blind, placebo-controlled trial at the Emergency Headache Centre in Paris, France, they enrolled adults aged 18—65 years with more than two cluster headache attacks per day. They randomly allocated patients to receive three suboccipital injections (48—72 h apart) of cortivazol 3.75 mg or placebo, as add-on treatment to oral verapamil in patients with episodic cluster headache and as add-on prophylaxis for those with chronic cluster headache, on the basis of a computer-generated list (blocks of four for each stratum). Between November, 2008, and July, 2009, they randomly allocated 43 patients (15 with chronic and 28 with episodic cluster headache) to receive cortivazol or placebo.

20 of 21 patients who received cortivazol had a mean of two or fewer daily attacks after injections compared with 12 of 22 controls (odds ratio 14.5). Patients who received cortivazol also had fewer attacks (mean 10.6) in the first 15 days of study than did controls (30.3; mean difference 19.7). They noted no serious adverse events, and 32 (74%) of 43 patients had other adverse events (18 of 21 patients who received cortivazol and 14 of 22 controls); the most common adverse events were injection-site neck pain and non-cluster headache.

The researchers concluded: "Suboccipital cortivazol injections can relieve cluster headaches rapidly in patients having frequent daily attacks, irrespective of type (chronic or episodic). Safety and tolerability need to be confirmed in larger studies."

Sounds interesting. Is Botox next?

For the full abstract, click here.

The Lancet Neurology October 2011 10(10):891-897 © 2011 Elsevier Limited
Suboccipital steroid injections for transitional treatment of patients with more than two cluster headache attacks per day: a randomised, double-blind, placebo-controlled trial. Elizabeth Leroux, Dominique Valade, Irina Taifas et al. Correspondence to Anne Ducros: anne.ducros@lrb.aphp.fr

Category: N. Neurological. Keywords: suboccipital, steroid, injections, cluster headaches, randomised, double-blind, placebo-controlled trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 14 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.