Lancet Neurol. 2011 Sep 6.
SUBOCCIPITAL STEROID INJECTIONS FOR TRANSITIONAL TREATMENT OF PATIENTS WITH MORE THAN TWO CLUSTER HEADACHE ATTACKS PER DAY: a randomised, double-blind, placebo-controlled trial.
Leroux E, Valade D, Taifas I, Vicaut E, Chagnon M, Roos C, Ducros A.
SourceEmergency Headache Centre, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

Abstract
BACKGROUND: Suboccipital steroid injections can be used for preventive treatment of cluster headache but few data are available for the efficacy of this approach in clinical trials. We aimed to assess efficacy and safety of repeated suboccipital injections with cortivazol compared with placebo as add-on therapy in patients having frequent daily attacks.

METHODS: In our randomised, double-blind, placebo-controlled trial at the Emergency Headache Centre in Paris, France, we enrolled adults aged 18-65 years with more than two cluster headache attacks per day. We randomly allocated patients to receive three suboccipital injections (48-72 h apart) of cortivazol 3·75 mg or placebo, as add-on treatment to oral verapamil in patients with episodic cluster headache and as add-on prophylaxis for those with chronic cluster headache, on the basis of a computer-generated list (blocks of four for each stratum). Injections were done by physicians who were aware of treatment allocation, but patients and the evaluating physician were masked to allocation. The primary outcome was reduction of the number of daily attacks to a mean of two or fewer in the 72 h period 2-4 days after the third injection. We assessed all patients who received at least one dose of study drug in the intention-to-treat analysis. This study is registered with ClinicalTrials.gov, number NCT00804895.

FINDINGS: Between November, 2008, and July, 2009, we randomly allocated 43 patients (15 with chronic and 28 with episodic cluster headache) to receive cortivazol or placebo. 20 of 21 patients who received cortivazol had a mean of two or fewer daily attacks after injections compared with 12 of 22 controls (odds ratio 14·5, 95% CI 1·8-116·9; p=0·012). Patients who received cortivazol also had fewer attacks (mean 10·6, 95% CI 1·4-19·9) in the first 15 days of study than did controls (30·3, 21·4-39·3; mean difference 19·7, 6·8-32·6; p=0·004). We noted no serious adverse events, and 32 (74%) of 43 patients had other adverse events (18 of 21 patients who received cortivazol and 14 of 22 controls; p=0·162); the most common adverse events were injection-site neck pain and non-cluster headache.

INTERPRETATION: Suboccipital cortivazol injections can relieve cluster headaches rapidly in patients having frequent daily attacks, irrespective of type (chronic or episodic). Safety and tolerability need to be confirmed in larger studies.

PMID:21903477[PubMed]

VERY interesting Bob.   Thanks for putting that here.  I would think however that because so many Drs. won't even prescribe oxygen, that this will take quite a long time to be used,  even WITH these initial  findings.   One can hope though and it looks like this could be very promising.

Hi,

I have posted, from Jan. 2008 about me useing Suboccipital steroid injections
with all the information....  Pic. and my  personal experience.... 
as well as relevant studies.....

I have paid a high price for this....... 
it is a very valid treatment!
and gave me a good portion of relief......

BUT!

(quote) "Safety and tolerability need to be confirmed in larger studies....."

I am still in treatment for the unwelcome effects of this treatment.....

If you have a chance to use this treatment......

do it!

just ask the treating medical establishment to monitor
for any added effects that are known to come with this treatment.

Michael

(Link to old Message Board,
Cluster Headache Help and support
Medications, Treatments, Therapies
Name: Suboccipital injection.)

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Michael: Many thanks. When I post an abstract it's with the assumption that the reader will pay attention to, as here, that last line warning.

But, in the haste to find relief, I also appreciate that many of us don't press our docs about the side effects potentials of any treatment we accept.

Your comments reinforce a response which we all should make a habit--ask.

Bob,

Is a suboccipital steroid injection the same as an Occipital nerve block?

I received an occipital nerve block on both sides during my last cycle, administered by Dr. Rozen. He said he has seen very good success in some patients. I unfortunately did not receive the benefits, the base of my skull and upper neck were numb for several days, but that was it.

Just curious and thanks for posting.

Baer

Baer: that's a subtle call that I can't make--sorry.

Any mention of how long it lasts? 
Is this a weekly or a monthly or a yearly set of injections?

All the information I have is posted.

Lobster,

Dr. Rozen, as I recall, did tell me they could be administered more than once if needed.

I do not know how long they have worked,or how many can or should be administered, as I did not receive any benefit.

I was told the benefits are quickly realized and unfortunately, I got none, so we did not feel the need to continue.

Like everything else we try, it appears that it is helpful to some, but not all of us.

I recommend trying anything at least once (within sound medical reason) as we could very well be amongst those that it will work. I stop short of playing with to many meds. as I've experienced less than desirable side effects at times.

The best course of action, is to work with a competent Neurologist who has CH experience and follow his advise.

All the best,

Baer

Quote:

Is a suboccipital steroid injection the same as an Occipital nerve block?

It is not the same! I have posted about both methods....
at the link I posted above.....


Quote:

Any mention of how long it lasts?

once up to 8 weeks....

I have posted this info. on the old as well as on the new board.....

And back to my obscurity......



Michael