大枕神经长效类固醇注射治疗丛集性头痛：一项观察性前瞻性研究。
Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study.
机构信息
IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, via Altura 3, Bologna, Italy.
DIBINEM, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
出版信息
J Neurol. 2022 Apr;269(4):2193-2199. doi: 10.1007/s00415-021-10884-0. Epub 2021 Nov 25.
BACKGROUND
Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection regimens. The aim of this study was to verify the effectiveness and safety of greater occipital nerve long-acting steroid injections in the management of episodic and chronic cluster headache.
METHODS
We conducted a prospective observational cohort study on episodic (ECH) and chronic cluster headache patients (CCH). ECH were included in the study at the beginning of a cluster period. Three injections with 60 mg methylprednisolone were performed on alternate days. We registered the frequency and intensity of attacks three days before and 3, 7 and 30 days after the treatment, the latency of cluster relapse, adverse events, scores evaluating anxiety (Zung scale), depression (Beck's Depression Scale) and quality of life (Disability Assessment Schedule II, 12-Item Self-Administered Version). Primary outcome was the interruption of the cluster after the three injections. Responders conducted a follow-up period of 12 months.
RESULTS
We enrolled 60 patients, 47 with ECH and 13 with CCH. We observed a complete response in 47.8% (22/46) of episodic and 33.3% (4/12) of chronic patients. Moreover, a partial response (reduction of at least 50% of attacks) was obtained in further 10.8% (5/46) of episodic and in 33.3% (4/12) of chronic patients at 1 month. Median pain-free period was of 3 months for CCH responders. Only mild adverse events were reported in 38.3% (23/58) cases.
CONCLUSIONS
We suggest three greater occipital nerve injections of 60 mg methylprednisolone on alternate days as useful therapy in episodic and chronic cluster headache. This leads to a long pain-free period in chronic forms. Adverse effects are mild and support its use as first choice.
TRIAL REGISTRATION
The study was inserted in AIFA observational studies register.
背景
针对枕大神经的注射用于减少偏头痛发作并在偏头痛患者中终止丛集性头痛发作。目前对于注射的最佳技术、使用的类固醇和/或麻醉剂的类型和剂量以及注射方案，尚未达成广泛接受的共识。本研究的目的是验证长效类固醇枕大神经注射治疗阵发性和慢性偏头痛的有效性和安全性。
方法
我们对阵发性偏头痛（ECH）和慢性偏头痛患者（CCH）进行了前瞻性观察队列研究。ECH 在丛集期开始时纳入研究。隔日进行 3 次 60mg 甲基强的松龙注射。我们在治疗前 3 天、治疗后 3、7 和 30 天登记发作的频率和强度、丛集复发的潜伏期、不良反应、评估焦虑的评分（Zung 量表）、抑郁（贝克抑郁量表）和生活质量（残疾评估表 II，12 项自我管理版）。主要结局是 3 次注射后中断丛集。有反应的患者进行了 12 个月的随访期。
结果
我们共纳入 60 例患者，其中 47 例为 ECH，13 例为 CCH。我们观察到 47.8%（22/46）的阵发性和 33.3%（4/12）的慢性患者完全缓解。此外，10.8%（5/46）的阵发性和 33.3%（4/12）的慢性患者在 1 个月时获得了部分缓解（发作减少至少 50%）。慢性患者的无疼痛期中位数为 3 个月。仅 38.3%（23/58）的病例报告了轻度不良反应。
结论
我们建议隔日进行 3 次 60mg 甲基强的松龙枕大神经注射，作为阵发性和慢性偏头痛的有效治疗方法。这导致慢性偏头痛患者出现较长的无疼痛期。不良反应较轻，支持将其作为首选治疗方法。
试验注册
该研究被纳入 AIFA 观察性研究注册。
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