Department of Basic and Clinical Neuroscience, Institute of Psychology, Psychiatry and Neuroscience, King's College London.
NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, UK.
Curr Opin Neurol. 2020 Jun;33(3):323-328. doi: 10.1097/WCO.0000000000000808.
Cluster headache is a neurological disorder that patients consider the most severe pain they experience. Recognizing new treatments provides opportunities to advance current management.
In contrast to the classic treatments, new options narrow in on the therapeutic target and are better tolerated. Calcitonin gene-related peptide (CGRP) pathway blockade with monoclonal antibodies (MABs), specifically the CGRP MAB galcanezumab, represents an important advance for episodic cluster headache, reducing the number of attacks during a bout. Neuromodulation strategies aimed at anatomical structures involved in the pathophysiology of cluster headache, such as the sphenopalatine ganglion and the vagus nerve, have proved effective in reducing the pain intensity and the number of attacks, and also to be safe and well tolerated.
Our understanding of the pathophysiology of cluster headache and its management continues to grow. Novel treatments have appeared from research, such as neuromodulation and CGRP monoclonal antibodies. Nonetheless, chronic cluster headache and designing trials that select the correct sham in evaluating devices remain challenging.
丛集性头痛是一种神经系统疾病，患者认为这是他们经历过的最严重的疼痛。认识到新的治疗方法为推进当前的治疗提供了机会。
与经典治疗方法相比，新的治疗方法针对治疗靶点，且具有更好的耐受性。降钙素基因相关肽（CGRP）单克隆抗体（MAB）阻断，特别是 CGRP MAB 加兰他敏，代表了丛集性头痛发作期治疗的一个重要进展，减少了发作次数。针对丛集性头痛病理生理学涉及的解剖结构的神经调节策略，如蝶腭神经节和迷走神经，已被证明能有效降低疼痛强度和发作次数，且安全且耐受性良好。
我们对丛集性头痛的病理生理学及其治疗的理解在不断发展。新的治疗方法已经从研究中出现，如神经调节和 CGRP 单克隆抗体。然而，慢性丛集性头痛和设计正确的假手术试验以评估设备仍然具有挑战性。
