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Posted on Mon, 19 Jun 2017 in Headache and Migraines
Question: I have a two year plus 24/7 one sided headache sometimes severe and others mild. Rheumatology treated with prednisone and within 2 days it was gone. I had it 9 months before that. Sed rate and C-Reactive protein negative. As we reduced the pred headache came back. Biopsy for arteritis was negative. They just diagnosed it as a pred sensitive headache. They mentioned Trigeminal Neuralgia, but felt the negatine blood work didn't fit.

I am on a reduction protocol of 10/8 lowered 1 mg per month. At the beginning of May I reduced to 8 and the severe face/ headache returned with a vengeance. Could these recent symptoms be related to the reduction?
Of course I still do not have diagnosis for the original facial/headache pain.
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Answered by Dr. Olsi Taka 39 minutes later
Brief Answer:
Prednisone reduction could be related.

Detailed Answer:
I read your question carefully and I understand your concern.

Regarding the question about the possibility that the return of the headache could be related to the reduction, yes, that is likely to be the case. Judging from your description of the efficacy of prednisone, it is well possible that a lowering of the dose may lead to a flaring of the symptoms, that is a known risk. So returning to 10 mg may be considered.

As for what it could be, temporal arteritis apart, unilateral headaches which respond to corticosteroids like prednisone would call for a consideration of cluster headache which responds well to prednisone. Chronic paroxysmal hemicrania has also been reported to respond to prednisone. These types of headaches come in short lasting attacks though and are associated with symptoms such as lacrimation, red eye, nasal congestion and discharge, if such features are not present it's unlikely. Hemicrania continua is another type of unilateral headache to be considered. I am sure these options must have been considered by your doctors though, they must have used that prednisone sensitive headache term because they found it impossible to classify it elsewhere, didn't include criteria for a specific kind.


I do not know what exams you have done. I do not see how could doctors exclude trigeminal neuralgia through blood work, it doesn't lead to any changes in blood tests, nor do the possibilities mentioned above. I would do (if not already done) a contrast MRI of the head. I would also consider a trial of Indomethacine, as its very effective in treatment of some unilateral headaches such as hemicranias continua and chronic paroxysmal hemicranias.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3657 Questions

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