Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: A double-blind placebo-controlled study

Anna Ambrosini, Michel Vandenheede, Paolo Rossi, Fulvio Aloj, Enzo Sauli, Francesco Pierelli, Jean Schoenen

Research output: Contribution to journalArticle

Abstract

Oral steroids can interrupt bouts of cluster headache (CH) attacks, but recurrence is frequent and may lead to steroid-dependency. Suboccipital steroid injection may be an effective 'single shot' alternative, but no placebo-controlled trial is available. The aim of our study was to assess in a double-blind placebo-controlled trial the preventative effect on CH attacks of an ipsilateral steroid injection in the region of the greater occipital nerve. Sixteen episodic (ECH) and seven chronic (CCH) CH outpatients were included. ECH patients were in a new bout since no more than 1 week. After a one-week run-in period, patients were allocated by randomization to the placebo or verum arms and received on the side of attacks a suboccipital injection of a mixture of long- and rapid-acting betamethasone (n=13; Verum-group) or physiological saline (n=10; Plac-group). Acute treatment was allowed at any time, additional preventative therapy if attacks persisted after 1 week. Three investigators performed the injections, while four others, blinded to group allocation, followed the patients. Follow-up visits were after 1 and 4 weeks, whereafter patients were followed routinely. Eleven Verum-group patients (3 CCH) (85%) became attack-free in the first week after the injection compared to none in the Plac-group (P=0.0001). Among them eight remained attack-free for 4 weeks (P=0.0026). Remission lasted between 4 and 26 months in five patients. A single suboccipital steroid injection completely suppresses attacks in more than 80% of CH patients. This effect is maintained for at least 4 weeks in the majority of them.

Original languageEnglish
Pages (from-to)92-96
Number of pages5
JournalPain
Volume118
Issue number1-2
DOIs
Publication statusPublished - Nov 2005

Fingerprint

Cluster Headache
Steroids
Placebos
Injections
Betamethasone
Occipital Lobe
Random Allocation
Outpatients
Research Personnel
Recurrence
Therapeutics

Keywords

  • Cluster headache
  • Steroids
  • Suboccipital injection
  • Treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Neurology
  • Neuroscience(all)
  • Pharmacology
  • Clinical Psychology

Cite this

Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache : A double-blind placebo-controlled study. / Ambrosini, Anna; Vandenheede, Michel; Rossi, Paolo; Aloj, Fulvio; Sauli, Enzo; Pierelli, Francesco; Schoenen, Jean.

In: Pain, Vol. 118, No. 1-2, 11.2005, p. 92-96.

Research output: Contribution to journalArticle

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