同侧耳部穿孔后连续性偏侧头痛的暂时缓解
Temporary resolution of hemicrania continua following ipsilateral ear piercing.
作者信息
Bryson Alexander
机构信息
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia.
出版信息
BMJ Neurol Open. 2021 Sep 27;3(2):e000193. doi: 10.1136/bmjno-2021-000193. eCollection 2021.
BACKGROUND
Hemicrania continua is an uncommon subtype of trigeminal autonomic cephalgia that exhibits dramatic therapeutic response to indomethacin. Unfortunately, indomethacin is associated with a range of adverse effects, including neuropsychiatric complications, which limits its use in many patients. Although no other effective pharmacologic agents exist, there is emerging evidence for interventional treatments such as occipital nerve and vagus nerve stimulation, which may act by modulating neural activity within the trigeminovascular system.
CASE
We present a 30-year-old woman with long-standing refractory hemicrania continua who suffered adverse effects to indomethacin. She experienced temporary, but near-complete, symptom resolution following piercing of the crus of the ear helix ipsilateral to her headache, whereas contralateral piercing produced no benefit.
CONCLUSIONS
To our knowledge, this case is the first to describe a therapeutic benefit following ear piercing in a patient with trigeminal autonomic cephalgia. We argue that symptom relief was obtained through a similar mechanism to occipital or vagus nerve stimulation.
背景
持续性偏侧头痛是三叉自主神经性头痛的一种罕见亚型，对吲哚美辛表现出显著的治疗反应。不幸的是，吲哚美辛会引发一系列不良反应，包括神经精神并发症，这限制了其在许多患者中的使用。尽管不存在其他有效的药物制剂，但越来越多的证据表明，枕神经和迷走神经刺激等介入治疗可能通过调节三叉神经血管系统内的神经活动发挥作用。
病例
我们报告一名30岁患有长期难治性持续性偏侧头痛的女性，她对吲哚美辛产生了不良反应。在穿刺其头痛同侧的耳轮脚后，她的症状得到了暂时但近乎完全的缓解，而对侧穿刺则没有效果。
结论
据我们所知，该病例是首例描述三叉自主神经性头痛患者耳穿刺后治疗获益的病例。我们认为，症状缓解是通过与枕神经或迷走神经刺激类似的机制实现的。
Zotero 插件