Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands.
Pain Pract. 2009 Nov-Dec;9(6):435-42. doi: 10.1111/j.1533-2500.2009.00331.x.
Cluster headache is a strictly unilateral headache that is associated with ipsilateral cranial autonomic symptoms and usually has a circadian and circannual pattern. Prevalence is estimated at 0.5 to 1.0/1,000. The diagnosis of cluster headache is made based on the patient's case history. There are two main clinical patterns of cluster headache: the episodic and the chronic. Episodic is the most common pattern of cluster headache. It occurs in periods lasting 7 days to 1 year and is separated by at least a 1-month pain-free interval. The attacks in the chronic form occur for more than 1 year without remission periods or with remission periods lasting less than 1 month. Conservative therapy consists of abortive and preventative remedies. Ergotamines and sumatriptan injections, sublingual ergotamine tartrate administration, and oxygen inhalation are effective abortive therapies. Verapamil is an effective and the safest prophylactic remedy. When pharmacological and oxygen therapies fail, interventional pain treatment may be considered. The effectiveness of radiofrequency treatment of the ganglion pterygopalatinum and of occipital nerve stimulation is only evaluated in observational studies, resulting in a 2 C+ recommendation. In conclusion, the primary treatment is medication. Radiofrequency treatment of the ganglion pterygopalatinum should be considered in patients who are resistant to conservative pain therapy. In patients with cluster headache refractory to all other treatments, occipital nerve stimulation may be considered, preferably within the context of a clinical study.
丛集性头痛是一种严格单侧的头痛,伴有同侧颅自主神经症状,通常具有昼夜和年周期模式。患病率估计为 0.5 至 1.0/1000。丛集性头痛的诊断基于患者的病史。丛集性头痛有两种主要的临床类型:发作性和慢性。发作性是最常见的丛集性头痛类型。它发生在持续 7 天至 1 年的期间内,与至少 1 个月的无痛间隔分开。慢性形式的发作持续超过 1 年,没有缓解期或缓解期持续少于 1 个月。保守治疗包括发作性和预防性治疗。麦角胺和舒马曲坦注射、舌下给予麦角胺酒石酸盐和吸氧是有效的发作性治疗。维拉帕米是一种有效且最安全的预防性治疗。当药物和氧疗失败时,可以考虑介入性疼痛治疗。翼腭神经节射频治疗和枕神经刺激的有效性仅在观察性研究中进行了评估,因此给出了 2C+的推荐。总之,主要治疗方法是药物治疗。对于对保守疼痛治疗有抵抗的患者,应考虑翼腭神经节射频治疗。对于所有其他治疗方法均无效的丛集性头痛患者,可考虑枕神经刺激,最好在临床研究的背景下进行。