重复使用糖皮质激素行枕大神经注射治疗药物难治性慢性丛集性头痛：一项回顾性研究。
Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study.
机构信息
Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.
Department of Anaesthesiology, Leiden University Medical Center, Leiden, Netherlands.
出版信息
Neurol Sci. 2022 Feb;43(2):1267-1272. doi: 10.1007/s10072-021-05399-5. Epub 2021 Jun 22.
INTRODUCTION
Current prophylactic drugs for cluster headache are associated with limited efficacy, serious side effects and poor tolerability. Greater occipital nerve injection (GON-injection) has been proven effective and safe as a single, one-time injection in episodic (ECH), and to a lesser extent, chronic cluster headache (CCH). We aim to analyse the effectiveness and safety of repeated GON-injections in medically intractable chronic cluster headache (MICCH).
METHODS
Clinical data of all cluster headache patients who had received at least one GON-injection between 2014 and 2018 in our tertiary headache centre were retrieved from patients' medical records. Clinical history was taken as part of routine care shortly before and 6 weeks after GON-injection.
RESULTS
We identified 47 MICCH patients (79 injections), and compared results with 22 non-MI CCH patients (30 injections) and 50 ECH patients (63 injections). Nineteen MICCH patients received repeated injections (32 in total, range 2-8). Rates of clinical relevant improvement to a first injection were similar in all groups (MICCH: 60%, non-MICCH 73%, ECH 76%; attack freedom: MICCH: 30%, non-MICCH 32%, ECH 43%). Furthermore, no difference in response to the first and second injection was shown between groups (all p > 0.29). Median effect duration in MICCH was 6 weeks (IQR 2.8-12 weeks). Side effects were only mild and local.
CONCLUSION
In this retrospective analysis, first and repeated GON-injections were well-tolerated and equally effective in MICCH as in non-MICCH, and ECH.
简介
目前用于丛集性头痛的预防性药物疗效有限，副作用严重，耐受性差。枕大神经注射（GON 注射）已被证明在发作性（ECH）中单次、一次性注射是有效且安全的，在慢性丛集性头痛（CCH）中效果稍差。我们旨在分析重复 GON 注射在医学上无法治疗的慢性丛集性头痛（MICCH）中的有效性和安全性。
方法
从我们的三级头痛中心的患者病历中检索了 2014 年至 2018 年间至少接受过一次 GON 注射的所有丛集性头痛患者的临床数据。临床病史是在 GON 注射前和 6 周后作为常规护理的一部分采集的。
结果
我们确定了 47 名 MICCH 患者（79 次注射），并将结果与 22 名非 MICCH 患者（30 次注射）和 50 名 ECH 患者（63 次注射）进行了比较。19 名 MICCH 患者接受了重复注射（共 32 次，范围 2-8 次）。所有组中首次注射临床相关改善的比例相似（MICCH：60%，非 MICCH：73%，ECH：76%；发作自由：MICCH：30%，非 MICCH：32%，ECH：43%）。此外，各组之间首次和第二次注射的反应无差异（所有 p 值均>0.29）。MICCH 的中位效应持续时间为 6 周（IQR 2.8-12 周）。副作用仅为轻度和局部性的。
结论
在这项回顾性分析中，首次和重复 GON 注射在 MICCH 中的耐受性和疗效与非 MICCH 和 ECH 相同。
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