University of Ottawa, Ottawa, Ontario, Canada.
SUNY Upstate Medical University, Syracuse, New York, USA.
Headache. 2022 Apr;62(4):482-511. doi: 10.1111/head.14283. Epub 2022 Mar 28.
We used network meta-analysis (NMA) to characterize the relative effectiveness and harms of acute treatment options for cluster headache.
There are few evidence-based acute treatments available for cluster headache. As most treatments were compared only against placebos in clinical trials, few head-to-head comparisons of treatments are available.
An a priori registered scoping review was performed to identify randomized controlled trials evaluating treatments in adult patients (>18 years old) with cluster headache per accepted diagnostic criteria. Bayesian NMAs were performed to compare treatments in terms of headache relief at 15 or 30 min, and also the occurrence of adverse events. We report odds ratios (ORs) of relative treatment effects along with corresponding 95% credible intervals (CrIs), as well as measures of treatment ranking.
A total of 13 randomized controlled trials informed NMAs. We found high flow oxygen to be the most effective therapy for headache response at 15 and 30 min (OR 9.0, 95% CrI 5.3 to 15.9 vs. placebo), with injectable sumatriptan demonstrating the next highest effect (OR 6.4, 95% CrI 3.75 to 11.1 vs. placebo). High flow oxygen was also more effective than low flow oxygen (OR 2.55, 95% CrI 1.13 to 5.8), nasal spray zolmitriptan (OR 3.75, 95% CrI 1.72 to 8.4), octreotide (OR 4.5, 95% CrI 1.64 to 12.5), and non-invasive vagal nerve stimulation (nVNS; OR 5.2, 95% CrI 2.29 to 11.9). Sumatriptan injectable was also effective for headache relief and was found to be better than nasal spray zolmitriptan (OR 2.67, 95% CrI 1.21 to 5.9), octreotide (OR 3.20, 95% CrI 1.17 to 8.8), and nVNS (OR 3.69, 95% CrI 1.63 to 8.4). Octreotide (OR 4.1, 95% CrI 1.71 to 10.5) and sumatriptan (OR 2.40, 95% CrI 1.39 to 4.2) were associated with greater risk of adverse events compared to placebo, while other treatments did not demonstrate increased risk. When focusing on patients with episodic cluster headache, nVNS was significantly better than placebo (OR 4.9, 95% CrI 1.89 to 14.1).
Our findings suggest that high flow oxygen is more efficacious when compared to low flow oxygen for headache relief. When low flow oxygen fails in patients who can tolerate oxygen, increased flow rates should be tried. Additionally, high flow oxygen is likely more effective than zolmitriptan nasal spray, nVNS, and octreotide. Sumatriptan injectable is more likely to be effective when compared to zolmitriptan nasal spray, octreotide, and nVNS.
我们使用网络荟萃分析（NMA）来描述丛集性头痛急性治疗方案的相对有效性和危害。
目前针对丛集性头痛，仅有少量基于证据的急性治疗方法。由于大多数治疗方法仅在临床试验中与安慰剂进行了比较，因此很少有治疗方法进行头对头比较。
我们进行了一项事先注册的范围性综述，以确定评估符合公认诊断标准的成年（>18 岁）丛集性头痛患者治疗方法的随机对照试验。我们进行贝叶斯 NMA 以比较 15 分钟或 30 分钟时头痛缓解的治疗方法，并比较不良事件的发生情况。我们报告相对治疗效果的优势比（OR）以及相应的 95%可信区间（CrI），以及治疗排序的衡量标准。
共有 13 项随机对照试验为 NMA 提供了信息。我们发现高流量氧气在 15 分钟和 30 分钟时对头痛缓解的效果最为显著（与安慰剂相比，OR 9.0，95%CrI 5.3 至 15.9），注射用舒马曲坦显示出下一个最高的效果（与安慰剂相比，OR 6.4，95%CrI 3.75 至 11.1）。高流量氧气也比低流量氧气更有效（OR 2.55，95%CrI 1.13 至 5.8）、比鼻腔喷雾佐米曲坦（OR 3.75，95%CrI 1.72 至 8.4）、比奥曲肽（OR 4.5，95%CrI 1.64 至 12.5）、以及比非侵入性迷走神经刺激（nVNS；OR 5.2，95%CrI 2.29 至 11.9）。注射用舒马曲坦也对头痛缓解有效，并且比鼻腔喷雾佐米曲坦（OR 2.67，95%CrI 1.21 至 5.9）、奥曲肽（OR 3.20，95%CrI 1.17 至 8.8）和 nVNS（OR 3.69，95%CrI 1.63 至 8.4）更有效。奥曲肽（OR 4.1，95%CrI 1.71 至 10.5）和舒马曲坦（OR 2.40，95%CrI 1.39 至 4.2）与安慰剂相比，发生不良事件的风险更高，而其他治疗方法则没有增加风险。当聚焦于发作性丛集性头痛患者时，nVNS 明显优于安慰剂（OR 4.9，95%CrI 1.89 至 14.1）。
我们的研究结果表明，与低流量氧气相比，高流量氧气在缓解头痛方面更有效。如果低流量氧气对能够耐受氧气的患者无效，应尝试增加氧气流量。此外，高流量氧气可能比佐米曲坦鼻腔喷雾、nVNS 和奥曲肽更有效。与佐米曲坦鼻腔喷雾、奥曲肽和 nVNS 相比，注射用舒马曲坦可能更有效。
