Kawada Sanami, Kashihara Kenichi, Imamura Takaki, Ohno Manabu
Department of Neurology, Okayama Kyokuto Hospital, 567-1 Kurata, Naka-ku, Okayama, 703-8265 Japan.
Springerplus. 2013 Apr 11;2(1):156. doi: 10.1186/2193-1801-2-156. Print 2013 Dec.
Triptans are effective for immediate relief of episodic cluster headache (CH) but do not reduce the frequency of attacks. Intravenous bolus injection of corticosteroids like methylprednisolone (MP) has been reported to decrease the frequency of CH attacks. We validated the prophylactic efficacy of MP pulse therapy by monitoring CH recurrence over several years following treatment of six consecutive male patients (mean age: 38.8 years, range: 26-54 years) afflicted by frequent (often daily) CH attacks.
Total MP dose per infusion was 250-500 mg for five patients and 125 mg for the sixth (a diabetic). High-dose MP was administered for 2 or 3 consecutive days in hospital for the first two patients treated. The next four patients received a single bolus injection at presentation, and in some cases a second injection days later at an outpatient clinic. The first two cases treated were also prescribed daily oral prednisolone for at most 6 months while the latter four cases were not. The frequency of CH attacks was markedly reduced in all patients, with intervals between attacks ranging from 4 to 23 months. We noted no apparent adverse events following MP administration.
High-dose MP therapy reduced CH attack frequency and improved patient quality of life.
曲坦类药物可有效立即缓解发作性丛集性头痛（CH），但不能降低发作频率。据报道，静脉推注皮质类固醇如甲泼尼龙（MP）可降低CH发作频率。我们通过监测6例连续患有频繁（通常为每日）CH发作的男性患者（平均年龄：38.8岁，范围：26 - 54岁）治疗后数年的CH复发情况，验证了MP脉冲疗法的预防效果。
5例患者每次输注的MP总剂量为250 - 500 mg，第6例（糖尿病患者）为125 mg。前两名接受治疗的患者在医院连续2或3天给予高剂量MP。接下来的4例患者在就诊时接受单次推注，在某些情况下，几天后在门诊进行第二次注射。前两例治疗患者还被处方每日口服泼尼松龙最多6个月，而后4例未服用。所有患者的CH发作频率均显著降低，发作间隔为4至23个月。我们注意到MP给药后无明显不良事件。
高剂量MP疗法降低了CH发作频率，改善了患者生活质量。
