From the Journal: Examining Whether Oral or Injected Steroids Are More Beneficial in Short-Term Treatment of Cluster Headache

A study published in Headache examined whether patients saw a better reduction in cluster headache from greater occipital nerve injections or oral steroids.

Cluster headache is a debilitating primary headache disorder characterized by severe unilateral head pain and ipsilateral cranial autonomic features like reddening of the white of the eye, tearing, and nasal congestion. The pain is typically centered around the eye, forehead and temple. A sense of restlessness and agitation is common during cluster attacks. Cluster headache is three times more common in men than women.

Since the benefits from preventive therapies can be delayed, clinicians often prescribe “transitional therapies” that can give patients relief from cluster headache in the interim. Two forms of transitional treatment are greater occipital nerve steroid injections and oral steroids. A recent study published in Headache: The Journal of Head and Face Pain, Greater Occipital Nerve Injection versus Oral Steroids for Short Term Prophylaxis of Cluster Headache: A Retrospective Study by Jerry Wei, MD, and Matthew S. Robbins, MD, investigated 43 patients to examine whether oral steroids or injected steroids were a more effective treatment option for cluster headache.

The study’s authors reviewed the charts of patients with cluster headache at the Montefiore Headache Center at the Department of Neurology in New York who received transitional therapy between 1995 to 2014. They classified the patients’ treatment benefit as either complete, partial or no response. Complete response meant no attacks occurred within one week of treatment. Partial response meant there was a reduction in the frequency of attacks within one week of treatment, and no response meant that there was either no change in the patients’ headache frequency or their headache attacks worsened.

Researchers analyzed 140 total transitional treatments in 40 patients, 81 of which were oral steroids (prednisone or dexamethasone), and 59 of which were local steroid injections in the region of the greater occipital nerve. In patients who received oral steroids, 50.6% had a complete response, 32.1% had a partial response, 8.6% had no response and 8.6% had an unclear response. In patients who were given local steroid injections, 35.6% had a complete response, 28.8% had a partial response, 18.6% had no response and 16.9% had an unclear response.

Sixteen patients in the study received both types of treatment. In this group, 50% experienced a reduction in headache frequency. In addition, 37.5% responded to oral steroids but not local steroid injections, while 6.3% responded to local steroid injections but not oral steroids.

The researchers concluded that although both therapies can be beneficial for short-term treatment of cluster headache, oral steroids may be more effective. No adverse effects were documented in either therapy. More research in the form of a randomized, blinded trial may be necessary in the future to further investigate this topic.

The American Headache Society is committed to keeping its members up to date on the most innovative and meaningful advancements in the realm of headache medicine. One of many initiatives to support that mission is our publication of Headache: The Journal of Head and Face Pain, published ten times per year, which highlights the latest findings in the realm of headache medicine research. Our “From the Journal” series offers a preview of some of the groundbreaking work detailed in Headache. Enjoy access to the full catalog of content plus a print subscription included with an American Headache Society Membership. Click here to become a member today.

  1. Wei, J., Robbins, M. S. (2018), Greater Occipital Nerve Injection versus Oral Steroids for Short Term Prophylaxis of Cluster Headache: A Retrospective Comparative Study. Headache: The Journal of Head and Face Pain. doi:10.1111/head.13338

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