OC-08 | Daily eletriptan significantly improves treatment-resistant cluster headache: a case series

Andrea Burgalassi,¹ Antonio Munafò,² Francesco De Cesaris,¹ Giulia Vigani,² Alberto Chiarugi^1,2 | ¹Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, Florence; ²Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy

Introduction: Although corticosteroids and verapamil (V) are currently used in the therapy of cluster headache (CH), data on this subject are limited. We report our results of an open clinical study on a series of patients (P) affected by Episodic Cluster Headache (ECH) treated with high doses of methylprednisolone (MP) iv and verapamil (V) per os.

Materials and methods: A series of 55 P (14 females, 41 males, 39.5 ± 11.0 years) was followed during 80 active cluster periods (CP). P received MP 250-500 mg/day iv for 5 days, then 120 mg im for 3 days, 80 mg im for 3 days and tapered prednisone per os in the following 8 day. Concomitantly, oral V was started or incremented up to 320-400 mg/day; and later, on the base of clinical results, up to 640 mg/day in selected cases. V was gradually tapered at least 30 days after the last attack.

Results: The 80 CP stopped within a week from the start of MP/V administration. In 61/80 (76%) CP there was no recurrence during a 6-month follow-up. In 13/80 (16%) CP a recurrence, but with mild attacks, was observed within the first month. In this group, an increase of V from 400 mg/day up to 640 mg/day blocked the attacks, with no further recurrence during a 6-month follow-up. In remaining 6/80 (8%) a reduction of > 50% in frequency/intensity and of > 75% in the length of CP was observed: however, in 3 cases the therapeutic protocol had not been constantly adhered to.

Conclusion: Data on this larger series of P the confirm the results we previously reported about the efficacy of high doses of MP iv and V per os in ECH. The association of the two drugs, along with their high doses and the timing of starting/tapering therapy, appear to be crucial in the stopping of CP.