Cluster Headache Cortivazol Injection (CHCI)

Cluster headache is characterized by unilateral attacks of severe periorbital pain accompanied by autonomic symptoms and restlessness. Though patients may respond to the standard prophylactic treatment of verapamil, some are refractory and continue to suffer from numerous attacks, with a limit of two doses of subcutaneous sumatriptan per day. Some patients also have contra-indications to standard prophylactic or acute treatments. Other preventive treatments like systemic steroids, lithium and methysergide may cause significant side effects. We intend to show the efficacy of occipital nerve injections with cortivazol, in adjunct to verapamil, in cluster headache patients. We expect a diminution of attack frequency over two weeks, with a protocol of three injections separated by two or three days each. Tolerance and safety will be examined.

Inclusion criteria

• patient age, man or woman whose age is between 18 and 65 included
• patient who signed a free express and informed consent
• patient with cluster headache, episodic or chronic according to the criteria of International Headache Society (ICHD-II)
• patient with more than two episodes of CH per day
• patient with a normal medical examination

Exclusion criteria

• patient not affiliated with a social security scheme (or beneficiary entitled)
• patient with another diagnosis ICHD-II,and being unable to differentiate CH attacks from its other cranial pain
• patient of CH having started his episodic active period more than 30 days ago
• patient with a contra-indication to verapamil
• patient with a known allergy to cortivazol
• patient with anticoagulant therapy or having a bleeding disorder
• patient unable to complete the schedule crisis
• patient non-compliant or unable to follow the research protocol
• women without contraception, pregnant, or nursing