Prednisone is better than placebo for short-term prevention of episodic cluster headaches and should be used as first-line treatment along with verapamil up-titration, according to a new multicentre, randomised controlled trial.

Investigators at 10 headache centres across Germany randomised 116 patients with episodic cluster headache to 100mg of oral prednisone for five days and 20mg tapering every three days, for a total of 17 days of drug exposure, or a placebo.

All patients (ages 18-65, mean age 41, 83% male) were within the first 30 days of a current pain episode. Study participants also started 40mg of oral verapamil three times a day, titrated up to 120mg three times a day by day 19.

During the first week, the 53 patients on prednisone had 7.1 attacks, on average, versus a mean of 9.5 attacks for the 56 placebo patients.