Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany.
Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany.
Eur J Neurol. 2023 Oct;30(10):2955-2979. doi: 10.1111/ene.15956. Epub 2023 Jul 28.
Cluster headache is a relatively rare, disabling primary headache disorder with a major impact on patients' quality of life. This work presents evidence-based recommendations for the treatment of cluster headache derived from a systematic review of the literature and consensus among a panel of experts.
The databases PubMed (Medline), Science Citation Index, and Cochrane Library were screened for studies on the efficacy of interventions (last access July 2022). The findings in these studies were evaluated according to the recommendations of the European Academy of Neurology, and the level of evidence was established using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).
For the acute treatment of cluster headache attacks, there is a strong recommendation for oxygen (100%) with a flow of at least 12 L/min over 15 min and 6 mg subcutaneous sumatriptan. Prophylaxis of cluster headache attacks with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy and tolerability) is recommended. Corticosteroids are efficacious in cluster headache. To reach an effect, the use of at least 100 mg prednisone (or equivalent corticosteroid) given orally or at up to 500 mg iv per day over 5 days is recommended. Lithium, topiramate, and galcanezumab (only for episodic cluster headache) are recommended as alternative treatments. Noninvasive vagus nerve stimulation is efficacious in episodic but not chronic cluster headache. Greater occipital nerve block is recommended, but electrical stimulation of the greater occipital nerve is not recommended due to the side effect profile.
丛集性头痛是一种相对罕见的、使人丧失能力的原发性头痛疾病，对患者的生活质量有重大影响。本项工作基于对文献的系统评价和专家组共识，为丛集性头痛的治疗提供了基于证据的推荐意见。
在 PubMed（Medline）、科学引文索引和 Cochrane 图书馆中筛选了关于干预措施疗效的研究（最后一次访问时间为 2022 年 7 月）。根据欧洲神经病学学会的建议评估这些研究中的发现，并使用 GRADE（推荐评估、制定与评价）建立证据水平。
对于丛集性头痛发作的急性治疗，有强烈的推荐使用氧（100%），流量至少为 12 L/min，持续 15 分钟，同时皮下注射 6mg 舒马曲坦。推荐使用维拉帕米进行预防性治疗，每日剂量至少为 240mg（最大剂量取决于疗效和耐受性）。皮质类固醇在丛集性头痛中有效。为了达到效果，建议口服至少 100mg 泼尼松（或等效皮质类固醇），或每天静脉注射高达 500mg，连续 5 天。锂、托吡酯和加奈珠单抗（仅用于发作性丛集性头痛）被推荐为替代治疗药物。非侵入性迷走神经刺激对发作性但不是慢性丛集性头痛有效。枕大神经阻滞被推荐，但由于副作用谱，不推荐使用枕大神经电刺激。
