当前位置: X-MOL 学术CNS Drugs › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Pharmacotherapy for Cluster Headache.
CNS Drugs ( IF 6 ) Pub Date : 2020-02-01 , DOI: 10.1007/s40263-019-00696-2
Roemer B Brandt 1, 2 , Patty G G Doesborg 1 , Joost Haan 1, 2 , Michel D Ferrari 1 , Rolf Fronczek 1
Affiliation  

Cluster headache is characterised by attacks of excruciating unilateral headache or facial pain lasting 15 min to 3 h and is seen as one of the most intense forms of pain. Cluster headache attacks are accompanied by ipsilateral autonomic symptoms such as ptosis, miosis, redness or flushing of the face, nasal congestion, rhinorrhoea, peri-orbital swelling and/or restlessness or agitation. Cluster headache treatment entails fast-acting abortive treatment, transitional treatment and preventive treatment. The primary goal of prophylactic and transitional treatment is to achieve attack freedom, although this is not always possible. Subcutaneous sumatriptan and high-flow oxygen are the most proven abortive treatments for cluster headache attacks, but other treatment options such as intranasal triptans may be effective. Verapamil and lithium are the preventive drugs of first choice and the most widely used in first-line preventive treatment. Given its possible cardiac side effects, electrocardiogram (ECG) is recommended before treating with verapamil. Liver and kidney functioning should be evaluated before and during treatment with lithium. If verapamil and lithium are ineffective, contraindicated or discontinued because of side effects, the second choice is topiramate. If all these drugs fail, other options with lower levels of evidence are available (e.g. melatonin, clomiphene, dihydroergotamine, pizotifen). However, since the evidence level is low, we also recommend considering one of several neuromodulatory options in patients with refractory chronic cluster headache. A new addition to the preventive treatment options in episodic cluster headache is galcanezumab, although the long-term effects remain unknown. Since effective preventive treatment can take several weeks to titrate, transitional treatment can be of great importance in the treatment of cluster headache. At present, greater occipital nerve injection is the most proven transitional treatment. Other options are high-dose prednisone or frovatriptan.

中文翻译:

药物治疗丛集性头痛。

丛集性头痛的特点是发作持续15分钟至3小时,使单侧头痛或面部疼痛变得更加剧烈,被认为是最强烈的疼痛形式之一。丛集性头痛发作伴有同侧的自主神经症状,如上睑下垂,瞳孔缩小,面部发红或潮红,鼻塞,鼻溢液,眼眶周围肿胀和/或躁动或躁动。丛集性头痛治疗需要快速的流产治疗,过渡治疗和预防性治疗。预防和过渡治疗的主要目标是实现攻击自由,尽管这并非总是可能的。皮下注射舒马曲坦和高流量氧气是治疗丛集性头痛发作的最有效的流产治疗方法,但鼻内曲普坦等其他治疗方法可能有效。维拉帕米和锂是首选的预防药物,在一线预防性治疗中使用最广泛。鉴于其可能的心脏副作用,建议在使用维拉帕米治疗之前推荐心电图(ECG)。在用锂治疗之前和期间,应评估肝肾功能。如果维拉帕米和锂由于副作用无效,禁忌或停药,第二种选择是托吡酯。如果所有这些药物均无效,则可以使用证据水平较低的其他选择(例如褪黑激素,克罗米芬,二氢麦角胺,吡唑替芬)。但是,由于证据水平低,我们还建议考虑对难治性慢性丛集性头痛患者进行几种神经调节选择之一。尽管长期作用尚不清楚,但在加成治疗性丛集性头痛中,预防性治疗的新选择是加仑单抗。由于有效的预防性治疗可能需要数周时间才能滴定,因此过渡治疗对丛集性头痛的治疗非常重要。目前,枕骨大神经注射是最有效的过渡治疗方法。其他选择是大剂量泼尼松或弗罗曲坦。
更新日期:2020-01-29
down
wechat
bug