Suri Himanshu, Ailani Jessica
Department of Neurology, MedStar Georgetown University Hospital, 3800 Reservoir Rd, PHC-7, Washington, DC, 20007, USA.
Curr Neurol Neurosci Rep. 2021 May 5;21(7):31. doi: 10.1007/s11910-021-01114-1.
The treatment of cluster headache has evolved to include a handheld neuromodulation device and a monoclonal antibody in addition to more traditional agents.
Galcanezumab is an approved treatment for episodic cluster headache. The non-invasive vagal nerve stimulator has been shown to be effective as a treatment for episodic cluster headache. Dedicated pituitary imaging may not be necessary with a normal MRI of the brain. Cluster headache is the most common trigeminal-autonomic cephalalgia, characterized by unilateral, frequent, debilitating attacks associated with ipsilateral autonomic symptoms. Attacks have a circadian and, often, seasonal pattern with periods of remission that can last months to years in episodic patients. Though a rare disease, an increasing number of studies have revealed novel targets for treatment. Treatment in cluster headache should focus on early intervention to reduce frequency of attacks and the length of the cycle, which improves outcomes and disability. Acute therapy is used to treat attacks, while bridging and preventive therapies are combined to reduce cycle length. Case 1: A 43-year-old man presents with the chief complaint of severe headaches. Upon general examination, he seems uncomfortable, agitated, and exhausted. He states that he hasn't "slept in over a week because of debilitating headaches." His headaches start around the same time every night: when he lays down to go to sleep. The pain is described as sharp, like a "hot poker" to his left eye. His partner has noticed that his eye droops and turns red when the pain starts. The attacks come on abruptly and prevent him from sleeping. The severe pain lasts 30 to 45 min, but he has mild-to-moderate pain that lingers for the rest of the night. He has seen his primary care physician, an allergist, and an ear, nose, and throat (ENT) specialist before coming to see a neurologist. Similar headaches occurred last year during the month of October as well. On further questioning, he reports that these headache attacks have been occurring almost yearly for the past 7 years. Each year, these headaches come on as the weather is changing and occur on a nightly basis for about 3 to 4 weeks.
丛集性头痛的治疗方法不断发展，除了更传统的药物外，还包括一种手持式神经调节设备和一种单克隆抗体。
加卡尼单抗是发作性丛集性头痛的一种获批治疗药物。无创迷走神经刺激器已被证明可有效治疗发作性丛集性头痛。脑部MRI正常时，可能无需进行专门的垂体成像。丛集性头痛是最常见的三叉神经自主性头痛，其特征为单侧、频繁、使人衰弱的发作，并伴有同侧自主神经症状。发作具有昼夜节律，且通常有季节性模式，发作性患者的缓解期可持续数月至数年。尽管这是一种罕见疾病，但越来越多的研究揭示了新的治疗靶点。丛集性头痛的治疗应侧重于早期干预，以减少发作频率和周期长度，从而改善治疗效果并减少残疾。急性治疗用于治疗发作，而过渡治疗和预防性治疗相结合以缩短周期长度。病例1：一名43岁男性因严重头痛为主诉前来就诊。全身检查时，他看起来不舒服、烦躁且疲惫。他表示“由于使人衰弱的头痛，已经一周多没睡了”。他的头痛每天晚上大约在同一时间开始：当他躺下准备睡觉时。疼痛被描述为尖锐的，就像“热拨火棍”刺向他的左眼。他的伴侣注意到，疼痛发作时他的眼睛会下垂并变红。发作突然出现，使他无法入睡。剧烈疼痛持续30至45分钟，但他在夜间其余时间会有轻至中度疼痛。在来看神经科医生之前，他已经看过初级保健医生、过敏症专科医生和耳鼻喉科（ENT）专科医生。去年10月也曾出现类似头痛。进一步询问后，他报告说在过去7年里，这些头痛发作几乎每年都会出现。每年，这些头痛在天气变化时发作，每晚发作约3至4周。
