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Prednisone Taper Protocol


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I’m about to go back and try a prednisone taper - what is the MG per day/number of days you guys are prescribed when you go that route? It has been a few years and I do not recall what my script was exactly. Think it was something like 60mg for 3 days, 40mg for 2 days, 20 mg for one day, 10 mgs until the bottle was gone. Prednisone was the magic bullet for me back in 2018-2020, but I wasn’t aware of potential side effects as I am now. I don’t remember running into any issues personally. 

This is kind of the nuclear option for me - have busted 4 times with no results (has worked like magic for me the past couple of years), on day 8 of Vit D3 protocol (following to the T) but not sure if I can wait it out to see if it ends up working but I plan to continue regardless. 

I’m a month into this cycle and just had a 6 attack night. Really at the end of my rope. 

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For me, it has been:

prednisone 5mg oral tablet - 13 day taper

12 tabs x 2 days (60mg)

10 tabs x 3 days (50mg)

8 tabs x 3 days (40mg)

6 tabs x 2 days (30mg)

4 tabs x 2 days (20mg)

2 tabs x 1 day (10mg)

Stop

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In the "Treatment of Cluster Headache" that document he created for the American Headache Society, Dr. Goadsby says "1 mg/Kg up to 60 mg for four days tapering the dose over three weeks is a well accepted short-term preventive approach."  That was a few years ago.  The 2023 European Academy of Neurology treatment guidelines for CH, of which Goadsby was one of the authors, refer to "the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally." (I can only see the abstract of this article so I don't know what the taper is.)

In a 2020 study, patients were given "100 mg oral prednisone for 5 days followed by tapering of 20 mg every 3 days," so that's 18 days.   Another study in 2021 used that same protocol.

A comment on one of those studies mentioned "historical ambiguity about the optimal oral corticosteroid dosing regimen."  But maybe the higher initial level and/or longer duration than a typical approach is what is being used now.  As with many other treatments for CH (including busting), maybe the dosages creep up as people decide to throw more at this condition than they might otherwise have considered at first.

Sorry that busting isn't working for you this time!!!!!  Have you considered switching substances (from MM to L or seeds, for example), which does seem to help many people? 

 

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  • 1 month later...
On 5/9/2024 at 7:35 PM, CHfather said:

In the "Treatment of Cluster Headache" that document he created for the American Headache Society, Dr. Goadsby says "1 mg/Kg up to 60 mg for four days tapering the dose over three weeks is a well accepted short-term preventive approach."  That was a few years ago.  The 2023 European Academy of Neurology treatment guidelines for CH, of which Goadsby was one of the authors, refer to "the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally." (I can only see the abstract of this article so I don't know what the taper is.)

great info @CHfather.  I had the opportunity to meet with Dr.Goadsby a couple years ago, 10 months into a severe episode. I found him to be extremely empathetic to CH, but about as helpful as my other neurologist. He kept me on a 10 day steroid taper x1 month, and told me to take less imitrex. when I asked him about mushrooms, his response was, "what like those clusterbusters".  He definitely was not a fan and probably why I have waited so long to try alternative treatments.  I swear that half the battle of CH is managing my doctors. I wonder how many others on this site have also seen the same doctors, getting the same results. 

On 5/9/2024 at 7:35 PM, CHfather said:

 

 

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Goadsby led the gold-standard clinical trial of oxygen, for which we can all be grateful, and he seems to be a leader in pharmaceutical treatments for CH, but he indeed has been hostile to busting. It will be nice when clinical studies prove him wrong.

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