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Cluster Headache: A Review and Update in Treatment
Current Neurology and Neuroscience Reports ( IF 5.6 ) Pub Date : 2021-05-05 , DOI: 10.1007/s11910-021-01114-1
Himanshu Suri , Jessica Ailani

Purpose of Review

The treatment of cluster headache has evolved to include a handheld neuromodulation device and a monoclonal antibody in addition to more traditional agents.

Recent Findings

Galcanezumab is an approved treatment for episodic cluster headache. The non-invasive vagal nerve stimulator has been shown to be effective as a treatment for episodic cluster headache. Dedicated pituitary imaging may not be necessary with a normal MRI of the brain.

Summary

Cluster headache is the most common trigeminal-autonomic cephalalgia, characterized by unilateral, frequent, debilitating attacks associated with ipsilateral autonomic symptoms. Attacks have a circadian and, often, seasonal pattern with periods of remission that can last months to years in episodic patients. Though a rare disease, an increasing number of studies have revealed novel targets for treatment. Treatment in cluster headache should focus on early intervention to reduce frequency of attacks and the length of the cycle, which improves outcomes and disability. Acute therapy is used to treat attacks, while bridging and preventive therapies are combined to reduce cycle length.

Case 1: A 43-year-old man presents with the chief complaint of severe headaches. Upon general examination, he seems uncomfortable, agitated, and exhausted. He states that he hasn’t “slept in over a week because of debilitating headaches.” His headaches start around the same time every night: when he lays down to go to sleep. The pain is described as sharp, like a “hot poker” to his left eye. His partner has noticed that his eye droops and turns red when the pain starts. The attacks come on abruptly and prevent him from sleeping. The severe pain lasts 30 to 45 min, but he has mild-to-moderate pain that lingers for the rest of the night.

He has seen his primary care physician, an allergist, and an ear, nose, and throat (ENT) specialist before coming to see a neurologist.

Similar headaches occurred last year during the month of October as well. On further questioning, he reports that these headache attacks have been occurring almost yearly for the past 7 years. Each year, these headaches come on as the weather is changing and occur on a nightly basis for about 3 to 4 weeks.



中文翻译:

丛集性头痛:治疗的回顾与更新

审查目的

丛集性头痛的治疗已发展为除更传统的药物外,还包括手持式神经调节装置和单克隆抗体。

最近的发现

Galcanezumab是一种治疗发作性丛集性头痛的经过批准的治疗方法。非侵入性迷走神经刺激器已被证明可有效治疗发作性丛集性头痛。正常的脑部MRI可能无需进行专门的垂体成像。

概括

丛集性头痛是最常见的三叉神经自主性头痛,其特征是与同侧自主神经症状相关的单侧,频繁,使人衰弱的发作。发作具有昼夜节律,并且通常是季节性的,缓解期可能在发作性患者中持续数月至数年。尽管是一种罕见疾病,但越来越多的研究揭示了新的治疗靶标。丛集性头痛的治疗应着重于早期干预,以减少发作的频率和周期的长度,从而改善预后和残疾。急性疗法用于治疗发作,而桥接疗法和预防疗法相结合可缩短周期。

案例1:一名43岁的男子主诉严重头痛。经过全面检查,他似乎不舒服,烦躁和疲惫。他说,他“没有因为头痛使人衰弱而睡一个星期”。每天晚上大约在同一时间开始头痛:当他躺下睡觉时。这种疼痛被描述为剧烈的,就像他左眼的“热扑克”一样。他的伴侣已经注意到,当疼痛开始时,他的眼睛会下垂并变红。袭击突然发生,使他无法入睡。剧烈的疼痛持续30至45分钟,但他的轻度至中度疼痛持续了整整一夜。

在去看神经科医生之前,他已经看过他的初级保健医师,过敏症专家以及耳鼻喉专家。

去年10月期间,也发生了类似的头痛事件。在进一步询问时,他报告说,在过去7年中,这些头痛发作几乎每年都在发生。每年,这些头痛会随着天气的变化而增加,并且每晚发生约3至4周。

更新日期:2021-05-05
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