丛集性头痛的诊断、病理生理学和治疗:文献综述

Diagnosis,pathophysiology and treatment of cluster headache:a literature review

丛集性头痛是头部单侧疼痛,同时伴有同侧自主神经症状的三叉自主神经性头痛。在排除继发性病因外,根据ICHD-3的标准诊断丛集性头痛。丛集性头痛的病理生理机制通常与下丘脑、三叉神经和自主神经系统的异常活动有关。下丘脑在丛集发生中似乎起着基础性的作用。急性期治疗使用舒马曲普坦皮下注射和氧气吸入,预防性一线药物为维拉帕米,过渡性治疗为枕下类固醇注射。靶点神经调控和分子靶向药物也取得了新进展。

Cluster headache is a trigeminal autonomic cephalalgia characterised by strictly unilateral painful and ipsilateral autonomic symptoms.In addition to rule out secondary causes,cluster headache is diagnosed according to the criteria of ICHD-3.The pathophysiological mechanism of cluster headache is usually to involve an abnormal activity in the hypothalamus,the trigeminovascular system and the autonomic nervous system.The hypothalamus appears to play a fundamental role in the episode.In the acute phase,the patients are treated with subcutaneous injection of sumatriptan and oxygen inhalation.The first-line prophylactic drug is verapamil,and the transitional treatment is suboccipital steroid injection.Advances have also been made in targeting neuromodulatory and molecular drugs.