Possible new approach to reduce CH frequency! We'll watch for additional trials with hope!
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Springerplus. 2013 Apr 13 Dec.
HIGH-DOSE INTRAVENOUS METHYLPREDNISOLONE FOR THE PROPHYLACTIC TREATMENT OF CLUSTER HEADACHE.
Kawada S, Kashihara K, Imamura T, Ohno M.
SourceDepartment of Neurology, Okayama Kyokuto Hospital, 567-1 Kurata, Naka-ku, Okayama, 703-8265 Japan.

Abstract
BACKGROUND: Triptans are effective for immediate relief of episodic cluster headache (CH) but do not reduce the frequency of attacks. Intravenous bolus injection of corticosteroids like methylprednisolone (MP) has been reported to decrease the frequency of CH attacks. We validated the prophylactic efficacy of MP pulse therapy by monitoring CH recurrence over several years following treatment of six consecutive male patients (mean age: 38.8 years, range: 26-54 years) afflicted by frequent (often daily) CH attacks.

FINDINGS: Total MP dose per infusion was 250-500 mg for five patients and 125 mg for the sixth (a diabetic). High-dose MP was administered for 2 or 3 consecutive days in hospital for the first two patients treated. The next four patients received a single bolus injection at presentation, and in some cases a second injection days later at an outpatient clinic. The first two cases treated were also prescribed daily oral prednisolone for at most 6 months while the latter four cases were not. The frequency of CH attacks was markedly reduced in all patients, with intervals between attacks ranging from 4 to 23 months. We noted no apparent adverse events following MP administration.

CONCLUSIONS: High-dose MP therapy reduced CH attack frequency and improved patient quality of life.

KEYWORDS: Cluster headache, Methylprednisolone, Steroid pulse therapy

PMID:23667809[PubMed]

VERY interesting....

Back around 2003-4... after having eschewed medications of any kind for 7 years due to frustration with minimal efficacy and unacceptable side effects...I couldn't take it anymore and found the best neuro I've ever had. She's the one that initially said "I treat ch VERY aggressively"...which almost made me cry.

I presented in mid cycle (episodic at the time)...so didn't expect much. The FIRST thing she did was an IV of methylprednisolone (600 mg I think) followed by an oral taper of same. I'd never heard of it. It busted the cycle that very same day...within hours of the infusion...and lasted months and months.... through several normal cycles...until I went chronic. In MY world of ch...it was a MIRACLE.....

The next bad cycle...when verapamil and O2 and zomig ns weren't working...we tried the infusion again (she didn't like doing it as a routine)...it was totally ineffective...and I have never tried again...I'm thinking chronic vs episodic has something to do with that...

Thanks Bob for throwing this nugget into the pan...

Best,

Jon

Great to see another potential addition to what can help people with CH. Ideally the research needs to be repeated with a larger number of participants to get a better understanding of how effective it is, such as impact on episodic vs chronic.

Nice find, Bob. I would be curious to see if such high doses would affect the chances of osteo-necrosis later on.

Thanks, Bob.  However, having done a pred taper twice I'll not be trying this one.  i really don't see much difference between the IV form and the oral form other than method of treatment.  Perhaps a higher initial dose, but for me the risks and the side effects outweigh any possible gain. 

Jerry