Department of Clinical Neurosciences, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
Headache. 2013 Jul-Aug;53(7):1191-6. doi: 10.1111/head.12145. Epub 2013 Jun 14.
Cluster headache pain is very intense, usually increases in intensity very rapidly from onset, and attacks are often frequent. These clinical features result in significant therapeutic challenges. The most effective pharmacological treatment options for acute cluster attack include subcutaneous sumatriptan, 100% oxygen, and intranasal zolmitriptan. Subcutaneous or intramuscular dihydroergotamine and intranasal sumatriptan are additional options. Transitional therapy is applicable mainly for patients with high-frequency (>2 attacks per day) episodic cluster headache, and options include short courses of high-dose oral corticosteroids, dihydroergotamine, and occipital nerve blocks with local anesthetic and steroids. Prophylactic therapy is important both for episodic and chronic cluster headache, and the main options are verapamil and lithium. Verapamil is drug of first choice but may cause cardiac arrhythmias, and periodic electrocardiograms (EKGs) during dose escalation are important. Many other drugs are also in current use, but there is an insufficient evidence base to recommend them.
丛集性头痛的疼痛非常剧烈，通常从发作开始就迅速加剧，发作也常常很频繁。这些临床特征导致治疗极具挑战性。治疗急性丛集性头痛发作最有效的药物选择包括皮下注射舒马曲坦、100%氧气和鼻内给予佐米曲坦。皮下或肌肉内给予二氢麦角胺和鼻内给予舒马曲坦也是其他选择。过渡治疗主要适用于发作频繁（每天发作超过 2 次）的丛集性头痛患者，包括短期大剂量口服皮质类固醇、二氢麦角胺和局部麻醉药及皮质类固醇的枕神经阻滞。预防性治疗对发作性和慢性丛集性头痛都很重要，主要选择是维拉帕米和锂。维拉帕米是首选药物，但可能导致心律失常，因此在剂量调整期间进行定期心电图（EKG）检查非常重要。许多其他药物也在当前使用，但缺乏推荐它们的充分证据。
