Neurological Department, University Hospital Quirón Madrid, Madrid, Spain; Neurological Department, University Hospital Fundación Alcorcón, Alcorcón, Spain.
Headache. 2013 Oct;53(9):1401-14. doi: 10.1111/head.12193.
Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, and rhinorrhea (SUNCT). Conventional pharmacological therapy can be successful in the majority of trigeminal autonomic cephalalgias patients. Most cluster headache attacks respond to 100% oxygen inhalation, or 6 mg subcutaneous sumatriptan. Nasal spray of sumatriptan (20 mg) or zolmitriptan (5 mg) are recommended as second choice. The bouts can be brought under control by a short course of corticosteroids (oral prednisone: 60-100 mg/day, or intravenous methylprednisolone: 250-500 mg/day, for 5 days, followed by tapering off the dosage), or by long-term prophylaxis with verapamil (at least 240 mg/day). Alternative long-term preventive medications include lithium carbonate (800-1600 mg/day), methylergonovine (0.4-1.2 mg/day), and topiramate (100-200 mg/day). As a rule, paroxysmal hemicrania responds to preventive treatment with indomethacin (75-150 mg/day). A short course of intravenous lidocaine (1-4 mg/kg/hour) can reduce the flow of attacks during exacerbations of SUNCT. Lamotrigine (100-300 mg/day) is the preventive drug of choice for SUNCT. Gabapentin (800-2700 mg/day), topiramate (50-300 mg/day), and carbamazepine (200-1600 mg/day) may be of help.
三叉自主神经性头痛包括丛集性头痛、阵发性偏头痛和短暂单侧神经痛性头痛伴结膜充血、流泪和流涕（SUNCT）。大多数三叉自主神经性头痛患者对常规药物治疗反应良好。大多数丛集性头痛发作对 100%氧气吸入或 6 毫克皮下舒马曲坦有效。推荐舒马曲坦鼻喷剂（20 毫克）或佐米曲坦（5 毫克）作为二线治疗药物。皮质类固醇（口服泼尼松：60-100 毫克/天，或静脉注射甲基强的松龙：250-500 毫克/天，连用 5 天，然后逐渐减少剂量）的短期疗程，或维拉帕米（至少 240 毫克/天）的长期预防治疗可以控制发作。替代的长期预防药物包括碳酸锂（800-1600 毫克/天）、麦角乙脲（0.4-1.2 毫克/天）和托吡酯（100-200 毫克/天）。一般来说，阵发性偏头痛对预防性使用吲哚美辛（75-150 毫克/天）有反应。静脉内利多卡因（1-4 毫克/公斤/小时）的短期疗程可减少 SUNCT 发作加剧期间的发作次数。拉莫三嗪（100-300 毫克/天）是 SUNCT 的首选预防药物。加巴喷丁（800-2700 毫克/天）、托吡酯（50-300 毫克/天）和卡马西平（200-1600 毫克/天）可能有帮助。
