Pageler L., Katsarava Z., Diener H-C., Limmroth V.
Prednisone vs. placebo in withdrawal therapy following medication overuse headache
Cephalalgia. 2008 Feb;28(2):152-6 (© Blackwell Publishing Ltd)This proof-of-concept study evaluates the potential clinical efficacy of prednisone for the treatment of withdrawal symptoms in patients with medication overuse headache (MOH) in a randomized, placebo-controlled, double-blind design. Twenty patients were randomized and underwent in-patient withdrawal therapy; complete sets of data are available for 18 patients (each group n = 9). The total number of hours with severe or moderate headache within the first 72 and 120 h was significantly lower in the prednisone group (18.1 vs. 36.7 h, P = 0.031, and 27.22 vs. 42.67 h, P = 0.05). Patients in the prednisone group requested rescue medication less frequently than those of placebo group, which however, did not reach significance (11 dosages vs. 21 dosages, P = 0.3). These results suggest that prednisone could be effective in treatment of medication withdrawal headache and that the drug may facilitate withdrawal therapy. Since this trial was planned as a proof-of-concept study, only 20 patients were enrolled. Although the results are clearly in favour of prednisone therapy, this is a shortcoming of the study because the small number of patients does not allow subgroup analysis regarding the influence of the primary headache type, accompanying withdrawal symptoms, substance use, or gender. Mechanisms leading to MOH are still little known. Down-regulation of serotonin-receptors (5-HT1B/D) or prostaglandin-synthesizing enzymes in anatomical structures that are involved in the transmission and modulation of nociceptive signals may lead to an impairment of antinociceptive activity and subsequently result in a permanent feeling of headache. The possible action of steroids in the treatment of MOH and other headaches such as cluster headache or status migrainosus still needs to be determined. The anti-inflammatory effect and the inhibition of cyclooxygenase, isoform II in particular, are possible mechanisms responsible for the positive effect of prednisone.
(summary of the original article by H. Duyver)