Treatment

Transitional and bridging therapy

Short-term treatment used to suppress attacks quickly while longer-term prevention, usually verapamil, is being started or increased.

Clinically reviewed · This page was clinically reviewed on 8 September 2026. It is based on ICHD-3 criteria and published clinical guidelines, and is not a substitute for medical advice. How we prepare clinical content

This needs medical supervision

Corticosteroids can be very useful in cluster headache, but they are not benign. Do not start, stop, repeat or extend steroid treatment without your GP or specialist.

What transitional therapy means

Transitional therapy, sometimes called bridging therapy, is short-term treatment used at the start of a cluster period or during a severe flare. The goal is to reduce attacks quickly while a preventive treatment has time to work.

This matters because verapamil often needs careful titration and ECG monitoring before it reaches an effective dose. A patient may need relief now, not in two or three weeks.

Prednisone or prednisolone

International reviews and guidelines commonly describe oral corticosteroids as a bridge for cluster headache. In New Zealand practice, this may be prescribed as prednisone or prednisolone depending on the clinician and available product.

Dosing and taper schedules vary. Published reviews describe approaches such as high-dose prednisone or prednisolone for several days followed by a taper over roughly two to three weeks. The exact plan should be individualised by your GP or neurologist, taking into account your other conditions and medicines.

Why it is not a long-term preventive

Steroids can cause insomnia, mood changes, raised blood glucose, stomach irritation, fluid retention, blood pressure changes, infection risk and other adverse effects. Repeated or prolonged courses carry additional risks. This is why steroids are usually used as a short-term bridge, not as ongoing maintenance.

Greater occipital nerve block

A greater occipital nerve block is an injection near the back of the head, often using local anaesthetic and corticosteroid. It is used by some neurologists and pain specialists as a transitional treatment, particularly when oral steroids are unsuitable or when a targeted approach is preferred.

Access in New Zealand varies by region and service. It is generally something to discuss with a neurologist or headache specialist rather than expecting it to be available from every GP clinic.

How this fits with oxygen, sumatriptan and verapamil

Oxygen and sumatriptan are acute treatments for individual attacks.
Verapamil is the usual first-line daily preventive.
Prednisone, prednisolone or nerve block may bridge the period before prevention is working.

What to ask your GP or neurologist

Would a short steroid bridge be appropriate while verapamil is started or increased?
What dose and taper schedule are appropriate for my risk profile?
Do I need stomach protection, blood pressure checks or blood glucose monitoring?
Are there reasons I should avoid steroids, such as diabetes, bipolar disorder, infection risk, glaucoma, stomach ulcer history or osteoporosis?
Would a greater occipital nerve block be an option in my region?

References and NZ resources

Drug Treatment of Cluster Headache - review covering bridging or transitional therapy.
Treatment of Cluster Headache - review describing transitional prophylaxis and steroid use.
American Family Physician rapid evidence review - includes transitional therapy.
Health New Zealand oral steroids information - NZ patient information for prednisone.
Medsafe prednisone data sheet - New Zealand medicine safety information.