Ekbom K
Department of Neurology, Söder Hospital, Stockholm, Sweden.
Cephalalgia. 1995 Oct;15 Suppl 15:33-6. doi: 10.1111/J.1468-2982.1995.TB00046.X.
The spontaneous capricious course of cluster headache may give rise to some problems when treatment is being evaluated. This is one of several explanations for there being so few well-designed, randomized, double-blind clinical trials in cluster headache. The standard treatment of acute attacks of cluster headache is inhalation of 100% oxygen. In the prophylaxis of episodic cluster headache, ergotamine, verapamil, lithium, serotonin, inhibitors and steroids are used. In chronic cluster, lithium is the drug of choice, but verapamil may also be tried. Recently, hyperbaric oxygen has been shown to immediately abort acute attacks, and it seems that it may also be useful in the prophylactic treatment. The introduction of the novel 5HT1 agonist sumatriptan as a symptomatic relief of cluster attacks represents further significant progress. Two randomized, double-blind, placebo-controlled, cross-over trials have shown sumatriptan 6 mg sc to be a rapid, effective and well-tolerated acute treatment for cluster headache attacks. Within 15 min of treatment, 74% of attacks on sumatriptan responded compared to 26% of placebo-treated attacks. Functional disability was also significantly improved. Increasing the dose to 12 mg did not offer significantly greater relief compared to sumatriptan 6 mg, but was associated with an increased incidence of adverse events. Interim analysis of 3 months of data from a recent multinational open trial comprising, 138 patients having treated 6353 attacks with subcutaneous sumatriptan 6 mg revealed a headache relief in 96% of attacks treated. There was no evidence of an increased incidence of adverse events with frequent use of sumatriptan. No tachyphylaxis was seen over the 3 months, suggesting that sumatriptan is effective and well tolerated also in long-term acute treatment for cluster headache.
在评估丛集性头痛的治疗时，其自发多变的病程可能会引发一些问题。这是丛集性头痛领域设计良好的随机双盲临床试验如此之少的几种解释之一。丛集性头痛急性发作的标准治疗方法是吸入100%的氧气。在发作性丛集性头痛的预防中，使用麦角胺、维拉帕米、锂盐、5-羟色胺抑制剂和类固醇。在慢性丛集性头痛中，锂盐是首选药物，但也可以尝试使用维拉帕米。最近，高压氧已被证明可立即终止急性发作，而且似乎在预防性治疗中也可能有用。新型5-羟色胺1（5HT1）激动剂舒马曲坦用于缓解丛集性头痛发作是又一重大进展。两项随机、双盲、安慰剂对照的交叉试验表明，皮下注射6毫克舒马曲坦是治疗丛集性头痛发作的快速、有效且耐受性良好的急性治疗方法。治疗后15分钟内，使用舒马曲坦的发作中有74%得到缓解，而安慰剂治疗的发作中这一比例为26%。功能障碍也有显著改善。与6毫克舒马曲坦相比，将剂量增加到12毫克并没有带来明显更大的缓解，但不良事件的发生率有所增加。对最近一项跨国开放试验3个月数据的中期分析显示，138名患者使用皮下注射6毫克舒马曲坦治疗了6353次发作，其中96%的发作头痛得到缓解。没有证据表明频繁使用舒马曲坦会增加不良事件的发生率。在3个月内未观察到快速耐受性，这表明舒马曲坦在丛集性头痛的长期急性治疗中也是有效且耐受性良好的。
