de Freitas Dias Bruna, Robinson Christopher L, Villar-Martinez Maria Dolores, Ashina Sait, Goadsby Peter J
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Pain Ther. 2025 Feb;14(1):1-19. doi: 10.1007/s40122-024-00674-7. Epub 2024 Nov 3.
Cluster headache (CH) is an excruciating and debilitating primary headache disorder. The prevalence is up to 1.3%, and the typical onset is around age 30. Often misdiagnosed as migraine, particularly in children, the diagnosis rate of CH has been increasing among women. CH is characterized by intense unilateral pain and autonomic symptoms, significantly impacting patients' quality of life, mental health, and productivity.Genetic associations suggest a familial risk for developing CH, with lifestyle factors also potentially playing a role. The pathophysiology involves alterations in both central and peripheral nervous system, with the hypothalamus, trigeminocervical complex, and neuropeptides such as calcitonin gene-related peptide (CGRP) being implicated.Nonpharmacological treatments focus on patient education and lifestyle modifications, while pharmacological treatments include acute therapies such as oxygen and subcutaneous or nasal sumatriptan, as well as preventive therapies like verapamil, lithium, and CGRP monoclonal antibodies. Transitional options include oral corticosteroids and greater occipital nerve injections. Emerging interventional procedures offer new avenues for managing refractory cases. Noninvasive vagal nerve stimulation and occipital nerve stimulation show promise for both acute and preventive treatment. Careful consideration of safety profiles is crucial in specific populations such as pregnant patients and children.Current treatments still leave patients highly burdened by limited efficacy and side effects. Future research continues to explore novel pharmacological targets, interventional procedures, and the potential role of psychedelics in CH management. Comprehensive, multifaceted treatment strategies are essential to improve the daily functioning and quality of life for individuals with CH.
丛集性头痛（CH）是一种极其痛苦且使人衰弱的原发性头痛疾病。患病率高达1.3%，典型发病年龄在30岁左右。CH常被误诊为偏头痛，尤其是在儿童中，女性的CH诊断率一直在上升。CH的特点是单侧剧痛和自主神经症状，严重影响患者的生活质量、心理健康和生产力。遗传关联表明患CH存在家族风险，生活方式因素也可能起作用。其病理生理学涉及中枢和外周神经系统的改变，下丘脑、三叉神经颈复合体以及降钙素基因相关肽（CGRP）等神经肽与之相关。非药物治疗侧重于患者教育和生活方式改变，而药物治疗包括急性治疗，如吸氧以及皮下或鼻腔注射舒马曲坦，还有预防性治疗，如维拉帕米、锂盐和CGRP单克隆抗体。过渡性选择包括口服糖皮质激素和枕大神经注射。新兴的介入手术为治疗难治性病例提供了新途径。无创迷走神经刺激和枕神经刺激在急性和预防性治疗方面都显示出前景。在孕妇和儿童等特定人群中，仔细考虑安全性至关重要。目前的治疗方法仍使患者因疗效有限和副作用而负担沉重。未来的研究继续探索新的药物靶点、介入手术以及迷幻药在CH管理中的潜在作用。全面、多方面的治疗策略对于改善CH患者的日常功能和生活质量至关重要。
