Lansbergen Casper S, Fronczek Rolf, Wilbrink Leopoldine A, Cohen Steven P, de Vos Cecile C, Huygen Frank J P M
Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
Pain Pract. 2025 Jun;25(5):e70050. doi: 10.1111/papr.70050.
Cluster headache is a rare primary headache disorder characterized by excruciating unilateral pain around the eye, lasting between 15 and 180 min, accompanied by ipsilateral cranial autonomic symptoms. Cluster headache is classified into two forms: episodic and chronic, with chronic cluster headache defined by pain-free intervals of less than 3 months between bouts. Both drug-based and invasive treatments are available for abortive and preventive purposes. Treatment selection depends on individual efficacy and tolerance, with invasive options considered when pharmacological treatments prove ineffective.
This narrative review summarizes the literature on common practice and the evidence in the treatment of cluster headache.
Oxygen therapy and subcutaneous sumatriptan are the most effective abortive treatments for cluster headache. Oral corticosteroid tapering regimens can be used as bridging therapy. Verapamil, lithium, topiramate, and CGRP antagonists are potential preventive medication options. Greater occipital nerve (GON) injections and radiofrequency (RF) therapy can be used as preventive treatments, though their effects are often temporary. For refractory chronic cluster headache, occipital nerve stimulation (ONS) has proven to be effective. Deep brain stimulation (DBS) may also be considered if all other treatments have failed.
The management of cluster headache is complex due to the variable efficacy of treatments across different patients and limited evidence.
丛集性头痛是一种罕见的原发性头痛疾病，其特征为眼部周围剧烈的单侧疼痛，持续15至180分钟，并伴有同侧颅神经自主症状。丛集性头痛分为两种类型：发作性和慢性，慢性丛集性头痛的定义是发作之间无疼痛间隔少于3个月。基于药物和侵入性治疗均可用于发作期治疗和预防性治疗。治疗选择取决于个体疗效和耐受性，当药物治疗无效时考虑侵入性治疗方案。
本叙述性综述总结了关于丛集性头痛治疗的常见做法和证据的文献。
氧气疗法和皮下注射舒马曲坦是治疗丛集性头痛最有效的发作期治疗方法。口服糖皮质激素逐渐减量方案可作为过渡治疗。维拉帕米、锂盐、托吡酯和降钙素基因相关肽（CGRP）拮抗剂是潜在的预防性药物选择。枕大神经（GON）注射和射频（RF）治疗可作为预防性治疗方法，但其效果通常是暂时的。对于难治性慢性丛集性头痛，枕神经刺激（ONS）已被证明是有效的。如果所有其他治疗均失败，也可考虑深部脑刺激（DBS）。
由于不同患者治疗效果的差异以及证据有限，丛集性头痛的管理较为复杂。
