Prednisolone / Prednisone 


Short-Term Preventative (Bridge Therapy)

Prednisolone (and its closely related form, prednisone) is a corticosteroid medication commonly used as a short-term treatment to rapidly suppress cluster headache attacks.

It is not a long-term preventative. Instead, it is used as a bridge to give relief while a main preventative (like verapamil) takes time to start working.

Steroids remain one of the fastest and most reliable ways to temporarily shut down cluster attacks.

Prednisone Vs Prednisolone

In Australia, prednisolone is usually preferred because your body has to convert prednisone into prednisolone before it works.

Both medications are corticosteroids and act almost identically once active in the body.
The difference is:

  • Prednisone is a pro-drug → inactive until your liver converts it into prednisolone.

  • Prednisolone is the active form → works immediately.

In acute cluster headache, speed matters — and some people have slower or less reliable liver conversion. This is why many Australian neurologists prescribe Prednisolone for cluster headache tapers.

That said, prednisone is still acceptable, and many doctors prescribe it out of habit because it is more common internationally.

What Prednisolone/Prednisone Is

  • A powerful anti-inflammatory steroid
  • Used for asthma, allergies, autoimmune conditions — and cluster headache
  • Works extremely quickly (often within 24–48 hours)
  • Typically used only for 5–14 days due to side effects with long courses

In CH, steroids “slam the brakes” on the trigeminal/autonomic inflammation driving the attacks.


How Steroids Work in Cluster Headache

Prednisolone suppresses:

  • trigeminal nerve inflammation
  • swelling and irritation behind the eye
  • the autonomic reflex loop that triggers attacks
  • inflammatory mediators that keep the cycle going

Many patients experience complete or near-complete relief within 1–2 days.


Why It’s Only Short-Term

Steroids are extremely effective — but only safe for limited periods.

Long-term steroid use can cause serious issues such as:

  • weight gain
  • mood changes
  • blood sugar spikes
  • insomnia
  • immune suppression
  • stomach irritation
  • bone thinning
  • adrenal suppression

Because of these risks, prednisolone is used only as a “rescue” or “bridge” treatment while preventatives like verapamil are being slowly increased.


Typical Dosing (Doctor-guided)

Common CH steroid tapers include:

Option A (very common):

  • 60 mg/day for 3–5 days
  • Then taper down by 10 mg every 2–3 days

Option B:

  • 50 mg/day for 5 days
  • Then 40 → 30 → 20 → 10 mg in steps every few days

Courses usually last 7–14 days total.

High starting doses work best.


What to Expect

Most people experience:

  • dramatic reduction in attacks
  • complete temporary remission in many cases
  • return of attacks as the taper gets low (e.g., 20–10 mg)

This is normal — steroids buy time until your preventative dose is therapeutic.


Common Side Effects

Short courses are usually well tolerated, but you may notice:

  • insomnia
  • increased appetite
  • irritability or “wired” feeling
  • stomach upset
  • sweating
  • mild swelling
  • increased energy

These improve once the course finishes.


Who Should Use With Caution

Prednisolone/prednisone may require extra caution in people with:

  • diabetes
  • high blood pressure
  • glaucoma
  • osteoporosis
  • stomach ulcers
  • infection
  • mood disorders

Doctors will tailor dosing to minimise risks.


Key Differences Between Prednisone and Prednisolone

Feature Prednisone Prednisolone
Active? Inactive until converted by the liver Already active
Onset Slightly slower Immediate
Preference in Australia Used, but less common Often preferred
Effectiveness Equivalent once converted More consistent

Both are suitable short-term treatments — prednisolone simply avoids the conversion step and may be easier on the liver.

Summary

Prednisolone/prednisone is one of the most effective short-term treatments for cluster headache. It is used for a limited number of days to suppress attacks quickly while longer-term preventatives (like verapamil) take effect.

✔ Fast relief
✔ Excellent as a “bridge” therapy
✔ Not for long-term use
✔ Prednisolone slightly preferred in Australia

Always taken under medical supervision.