Kashyap Priyanka V, Chabri Sounak
Department of Neurology, All India Institute of Medical Science (AIIMS), Saket Nagar, Bhopal, Madhya Pradesh, India.
Ann Neurosci. 2023 Oct;30(4):256-261. doi: 10.1177/09727531231173286. Epub 2023 Jun 1.
Headache is an extremely common symptom of the general outpatient department and also the headache clinic, with prevalence of 48.9% in the general population. None has ever experienced headache in life time. Headache is seen in 1 patient out of 10 general practitioner (GP) consultations, 1 referral out of 3 is headache in neurology OPD, and 1 in 5 of all emergency medical admissions. Of all headaches, around 98% constitute primary headache: migraine without aura, tension headache, and cluster headache. With advancement in various drug modalities, certain headache forms respond less well to the regular approved medications, and some headaches are complicated by the analgesic itself. Steroids have been tried in many subtypes of headache, especially in primary forms of headache with dysautonomia, headache with trigeminal pathway activation and disinhibition, and in certain medication-culprit headaches. This subgroup of headaches is almost a challenge in an emergency for the headache expert as well. So, we need to assess the role of steroids in less well-responsive headaches.
Current reviewed evidence on the role of steroids in primary headache suggests that steroids have a role in status migrainosus and medication overuse headache when used in the mentioned and monitored manner. Consideration and further exploration of its role in other primary headaches may reveal insight into steroid efficacy as a treatment modality in various subtypes of headache.
Steroids, when used cautiously in specifically selected primary headaches under supervision, proved miraculous where other modalities failed.
头痛是普通门诊以及头痛门诊极为常见的症状，普通人群中的患病率为48.9%。没有人一生中从未经历过头痛。在全科医生（GP）的每10次诊疗中就有1例头痛患者，在神经内科门诊的每3例转诊中有1例是头痛患者，在所有急诊入院患者中每5例就有1例头痛患者。在所有头痛类型中，约98%属于原发性头痛：无先兆偏头痛、紧张性头痛和丛集性头痛。随着各种药物治疗方法的进步，某些头痛类型对常规批准药物的反应较差，而且一些头痛会因镇痛药本身而变得复杂。类固醇已在多种头痛亚型中试用，尤其是在伴有自主神经功能障碍的原发性头痛、伴有三叉神经通路激活和去抑制的头痛以及某些药物性头痛中。这一头痛亚组对头痛专家来说在急诊中几乎也是一项挑战。因此，我们需要评估类固醇在反应较差的头痛中的作用。
目前关于类固醇在原发性头痛中作用的综述证据表明，类固醇以所述及的方式使用并受到监测时，在偏头痛持续状态和药物过量使用性头痛中具有一定作用。对其在其他原发性头痛中作用的考虑和进一步探索可能会揭示类固醇作为各种头痛亚型治疗方式的疗效。
在有监督的情况下，在特定选择的原发性头痛中谨慎使用类固醇时，在其他方法无效的情况下已证明其具有神奇效果。
