新型神经调节技术
新型神经调节技术包括有创性蝶腭神经节刺激和无创性迷走神经刺激。 蝶腭神经节是三叉神经-自主神经环路的关键部分,该环路可导致丛集性头痛发作时产生自主神经特征。 目前已经开发出专门用于治疗丛集性头痛的可植入微型设备。 证据显示,该设备用于治疗急性发作和作为潜在的预防治疗均有效。[57]Schoenen J, Jensen RH, Lantéri-Minet M, et al. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study. Cephalalgia. 2013;33:816-830.http://cep.sagepub.com/content/33/10/816.longhttp://www.ncbi.nlm.nih.gov/pubmed/23314784?tool=bestpractice.com[58]Jürgens TP, Barloese M, May A, et al. Long-term effectiveness of sphenopalatine ganglion stimulation for cluster headache. Cephalalgia. 2016 May 9 [Epub ahead of print].http://cep.sagepub.com/content/early/2016/05/11/0333102416649092.longhttp://www.ncbi.nlm.nih.gov/pubmed/27165493?tool=bestpractice.com 没有关于其长期疗效的证据。一种用于迷走神经无创性刺激的设备已经进行了试验,用于治疗慢性丛集性头痛。开放标签研究证据提示,使用辅助药物进行预防性治疗可能对预防丛集性头痛有效,且耐受性好,成本效益高。
A 型肉毒素
研究者已经发现A型肉毒毒素是一种有效的偏头痛预防疗法。[59]Dodick DW, Turkel CC, DeGryse RE, et al; PREEMPT Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50:921-936.http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2010.01678.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/20487038?tool=bestpractice.com 文献中有许多报告称A型肉毒毒素在慢性丛集性头痛中是有用的,尽管还没有进行相关的随机、安慰剂对照研究。[60]Sostak P, Krause P, Förderreuther S, et al. Botulinum toxin type-A therapy in cluster headache: an open study. J Headache Pain. 2007;8:236-241.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3451674/pdf/10194_2007_Article_400.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/17901920?tool=bestpractice.com[61]Robbins L. Botulinum toxin A (Botox) for cluster headache: 6 cases (P3-R18). Cephalalgia. 2001;21:499.http://onlinelibrary.wiley.com/doi/10.1046/j.1468-2982.2001.00031.x/pdf[62]Freund B, Schwartz M. The use of botulinum toxin A in the treatment of refractory cluster headache: case reports. Cephalalgia. 2000;20:329-330.[63]Smuts JA, Barnard PWA. Botulinum toxin type A in the treatment of headache syndromes: a clinical report of 79 patients. Cephalalgia. 2000;20:332.
心理治疗
放松训练、皮肤温度反馈和认知行为疗法可以帮助患者应对该疾病。[13]Beck E, Sieber WJ, Trejo R. Management of cluster headache. Am Fam Physician. 2005 Feb 15;71(4):717-24.http://www.aafp.org/afp/2005/0215/p717.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/15742909?tool=bestpractice.com