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For short-term prevention or for transition toward long-term prevention of cluster headache attacks, oral corticosteroids are recommended. However, inadequate level 1 evidence has supported this practice. This multicenter, double-blind, placebo-controlled trial included 109 patients with episodic cluster headache and previous bout durations >30 days. Participants were randomized to receive either placebo or 100 mg of oral prednisone daily for 5 days, followed by a taper of 20 mg every 3 days. All patients were also concurrently started on verapamil.
The primary endpoint was reduction in cluster headache attacks after 1 week of treatment. Prednisone was superior to placebo, resulting in an average of 2.4 fewer attacks than with placebo. The p…