Institute of Neurological Sciences, Prince of Wales Hospital, Level 2, High Street, Randwick, Sydney 2031, Australia and Prince of Wales Hospital Clinical School, University of New South Wales, Kensington, Sydney, 2052, Australia.
Curr Pain Headache Rep. 2018 Mar 19;22(4):23. doi: 10.1007/s11916-018-0677-5.
To review recent studies outlining the management of refractory primary headache patients, including emerging therapies such as neuromodulation. This includes both noninvasive and invasive neuromodulation techniques. Recent studies on the management of medication overuse headache were also reviewed.
There is no consensus as yet on the definitions of refractory chronic migraine and chronic cluster headache although there is broad agreement on some aspects of these terms. The importance of identifying medication overuse headache and dealing effectively with it has been highlighted in several studies although there is still not consensus on how best to achieve the cessation of medication overuse. Some recommend the use of preventative medication together with medication cessation, while others do not. Recent studies on neuromodulation have used both noninvasive vagal nerve stimulation as well invasive techniques. Recent studies using noninvasive vagal nerve stimulation for chronic migraine have been disappointing although the data in chronic cluster headache are more encouraging. Similarly, recent studies on occipital nerve stimulation have again been more positive in chronic cluster headache and generally negative in chronic migraine. In recent years, new forms of neuromodulation have emerged and long-term follow-up data from previous invasive neuromodulation techniques have become available. The sphenopalatine ganglion has been increasingly targeted by various interventions in several different headache types. Sphenopalatine ganglion stimulation is yielding encouraging data for the treatment of chronic cluster headache. New studies and long-term follow-up data from previous studies have provided further evidence for the benefit of deep brain stimulation for refractory chronic cluster headache although the exact target location is still debated. Data from phase 3 trials using CGRP monoclonal antibodies in chronic migraine and chronic cluster headache, if positive, may herald a long overdue, new and effective treatment for our refractory headache patients.
本文旨在综述难治性原发性头痛患者管理的最新研究，包括新兴疗法，如神经调节。这包括非侵入性和侵入性神经调节技术。本文还回顾了药物过度使用性头痛管理的最新研究。
虽然对于慢性偏头痛和慢性丛集性头痛的某些术语有广泛的共识，但对于难治性慢性偏头痛和慢性丛集性头痛的定义目前尚无共识。几项研究强调了识别药物过度使用性头痛并有效处理的重要性，尽管如何最好地实现药物戒断仍未达成共识。一些人建议使用预防性药物和药物戒断，而另一些人则不建议。最近的神经调节研究既使用了非侵入性迷走神经刺激，也使用了侵入性技术。虽然慢性丛集性头痛的数据更令人鼓舞，但最近使用非侵入性迷走神经刺激治疗慢性偏头痛的研究结果令人失望。同样，最近关于枕神经刺激的研究在慢性丛集性头痛中更为积极，而在慢性偏头痛中则普遍为阴性。近年来，出现了新形式的神经调节，以前的侵入性神经调节技术的长期随访数据也已可用。各种不同类型的头痛中，各种干预措施都越来越针对蝶腭神经节。蝶腭神经节刺激为慢性丛集性头痛的治疗提供了令人鼓舞的数据。新的研究和以前研究的长期随访数据进一步证明了深部脑刺激对难治性慢性丛集性头痛的益处，尽管确切的靶点位置仍存在争议。如果使用 CGRP 单克隆抗体治疗慢性偏头痛和慢性丛集性头痛的 3 期试验结果为阳性，可能预示着我们的难治性头痛患者即将迎来期待已久的、新的、有效的治疗方法。
