Episodic Cluster Headache: Short and Long Term Results of Prophylactic Treatment

SYNOPSIS We reviewed our experience with episodic cluster headache patients to evaluate both short and long term results of prophylactic treatment. 50 patients (46 M - 4 F) with episodic cluster headache were studied. During a follow-up period (mean duration 27.5 months, range 12–84) we studied: response to prophylactic treatment, relapses in responders, and response to the same prophylactic treatment when repeated in subsequent bouts. Drugs used were: Prednisone 50 mg/day; Nimodipine 120 mg/day; Lithium Carbonate 900 mg/day and Methysergide 6 mg/day. The patients were treated at the start of the cluster (within the first week of a bout); successful outcome was defined as the disappearance of attacks within seven days of treatment. Prednisone and Nimodipine gave positive results in over 50% of cases, Lithium Carbonate in 40% of cases, Methysergide in less than 30% of cases. Prednisone presented 33% of relapses; less relapses occurred with Lithium and Nimodipine. Treatment effectiveness tends to diminish in subsequent bouts irrespective of the drug used.