Continuum (Minneap Minn). 2021 Jun 1;27(3):732-745. doi: 10.1212/CON.0000000000000959.
Headache disorders are common and disabling, and many therapies that are effective and safe are procedural.
After pivotal clinical trials, onabotulinumtoxinA has become an established preventive therapy for chronic migraine; it is better tolerated than many other treatments and may be useful for other headache disorders. Peripheral nerve blocks, especially greater occipital nerve blocks, have amassed evidence from randomized trials in the acute and short-term preventive treatment of migraine and cluster headache. Trigger point injections and sphenopalatine ganglion blocks have recent trials suggesting efficacy and safety in properly selected patients. Medical education initiatives are needed to train neurologists in these procedures to help manage the large population of patients with headache disorders who need them.
Evidence exists for the efficacy and safety of procedural therapies to be incorporated into neurology practice for the management of patients with migraine, cluster headache, and other headache disorders.
头痛障碍很常见且使人丧失能力，许多有效且安全的治疗方法都是有创的。
在关键性临床试验之后，肉毒毒素 A 已成为慢性偏头痛的既定预防疗法；它比许多其他治疗方法更耐受，并且可能对其他头痛障碍有用。外周神经阻滞，特别是枕大神经阻滞，在偏头痛和丛集性头痛的急性和短期预防性治疗的随机试验中积累了证据。在适当选择的患者中，触发点注射和蝶腭神经节阻滞的最近试验表明其疗效和安全性。需要开展医学教育活动，培训神经科医生掌握这些操作，以帮助管理大量需要这些治疗的头痛障碍患者。
有证据表明，有创治疗方法对于将头痛障碍患者纳入神经病学实践管理中是有效且安全的。
