Bussone G, Leone M, Peccarisi C, Micieli G, Granella F, Magri M, Manzoni G C, Nappi G
Headache Centre, C. Besta Neurological Institute of Milan, Italy.
Headache. 1990 Jun;30(7):411-7. doi: 10.1111/j.1526-4610.1990.hed3007411.x.
Chronic Cluster Headache (CCH) treatment is troublesome; since there are no pain-free periods, it must be continuous. The most effective CCH prophylactic drug today is lithium carbonate but long-term use of this drug is limited by the possibility of side effects. Recently, calcium antagonists have been successfully employed to prevent migraine, and preliminary studies also indicate that verapamil in particular is an efficacious treatment for CCH. We have conducted a multicenter trial employing a double-dummy, double blind, cross-over protocol, comparing verapamil with the established efficacy of lithium carbonate, in preventing CCH attacks. Both lithium carbonate and verapamil were effective in preventing CCH but verapamil caused fewer side effects and had a shorter latency period. We did not observe any correlation between plasma levels of the two drugs and their clinical efficacy. Both the drugs tested here may exert their effect by restoring a normal inhibitory tone to the pain modulating pathways from the trigemino-vascular system, a circuit putatively implicated in CCH.
慢性丛集性头痛（CCH）的治疗颇为棘手；由于不存在无痛期，治疗必须持续进行。目前治疗CCH最有效的预防性药物是碳酸锂，但长期使用该药会受到副作用的限制。近来，钙拮抗剂已成功用于预防偏头痛，初步研究还表明，尤其是维拉帕米对CCH是一种有效的治疗方法。我们进行了一项多中心试验，采用双模拟、双盲、交叉方案，比较维拉帕米与已证实有效的碳酸锂预防CCH发作的效果。碳酸锂和维拉帕米在预防CCH方面均有效，但维拉帕米的副作用较少且潜伏期较短。我们未观察到两种药物的血浆水平与其临床疗效之间存在任何相关性。此处测试的两种药物可能都是通过恢复来自三叉神经血管系统的疼痛调节通路的正常抑制性张力来发挥作用的，该通路被认为与CCH有关。
