Santos Telma, Morais Hugo
Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.
Case Rep Neurol Med. 2016;2016:5230127. doi: 10.1155/2016/5230127. Epub 2016 Dec 29.
The management of cluster headache (CH) may be challenging. We report a 50-year-old male with recurrent attacks of dull and severe unilateral periorbital pain, lasting 30-45 minutes, twice a day, exclusively during sleep, and accompanied by ipsilateral rhinorrhea and lacrimation. The pain switched sides within every attack. CH treatment was initiated but the patient maintained recurrence rates compatible with chronic CH, even after increasing verapamil to 460 mg/day. Afterwards we decided to add lithium (800 mg/day). With this treatment the severity and recurrence of CH substantially decreased, despite the patient's autonomous decision to take lithium only during the acute phase of the cluster. The exclusively alternating location and the excellent response to short cycles of lithium represent two unique features of CH.
丛集性头痛（CH）的治疗可能具有挑战性。我们报告了一名50岁男性，反复出现钝痛和严重的单侧眶周疼痛发作，持续30 - 45分钟，每天两次，仅在睡眠期间发作，并伴有同侧鼻漏和流泪。每次发作时疼痛会转换部位。开始了CH治疗，但即使将维拉帕米增加到460毫克/天，患者的复发率仍与慢性CH相符。之后我们决定加用锂盐（800毫克/天）。采用这种治疗方法后，CH的严重程度和复发率大幅下降，尽管患者自主决定仅在丛集期急性期服用锂盐。CH独有的交替发作部位以及对短期锂盐治疗周期的良好反应是其两个独特特征。
