Department of Neurology and Westgerman Headache Center Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany,
Curr Treat Options Neurol. 2012 Feb;14(1):15-26. doi: 10.1007/s11940-011-0156-3.
Thus far, no data from randomized placebo-controlled clinical trials are available for hypnic headache, so current treatment recommendations are based on single case reports and smaller open case series. In the predominantly elderly patient population affected by this disease, tolerability of the substances used is at least as important as their efficacy. Caffeine is the preferable first-line therapy for both acute treatment (i.e., a cup of strong coffee when awaking with headache) and prophylaxis (a cup of strong coffee before going to bed). Sleep problems should be considered as substantial side effects of this therapy, although they seem to occur far less than expected. For acute treatment, analgesics containing caffeine are also effective, but they may carry the risk of medication-overuse headache. Treatments that not effective for acute pain relief include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, 100% oxygen, and acetaminophen Triptans may be effective in single cases. For prophylaxis, lithium should be tried as a second treatment option if caffeine intake is not effective or tolerated. Lithium has been reported to be effective in many patients, but it was often discontinued because of side effects. Indomethacin may be a viable option for third-line prophylactic therapy.
迄今为止，尚无关于催眠性头痛的随机安慰剂对照临床试验数据，因此目前的治疗建议基于单个病例报告和较小的开放性病例系列。在受这种疾病影响的主要是老年人的患者群体中，所用物质的耐受性至少与疗效一样重要。咖啡因是急性治疗（即头痛醒来时喝一杯浓咖啡）和预防（睡前喝一杯浓咖啡）的首选一线治疗药物。尽管睡眠问题似乎比预期的要少，但应将其视为这种治疗的严重副作用。对于急性治疗，含有咖啡因的镇痛药也有效，但它们可能存在药物过度使用性头痛的风险。对急性疼痛缓解无效的治疗方法包括非甾体抗炎药（NSAIDs）、阿片类药物、100%氧气和对乙酰氨基酚。曲普坦类药物在单个病例中可能有效。对于预防，如果咖啡因摄入无效或无法耐受，锂应作为二线治疗选择进行尝试。据报道，锂对许多患者有效，但由于副作用，锂经常被停用。吲哚美辛可能是三线预防性治疗的可行选择。
