Abstract

Regarding the preventive treatment of CH, there are few placebo-controlled studies, meaning most treatment recommendations by physicians are limited to results from open observational studies. Additionally, existing effective therapies are believed to be underused because of our underdiagnosis of CH syndrome. Numerous treatment methods are available for different CH attack stages, making them difficult to manage. Some treatment options include inhalation of 100% oxygen or subcutaneous/intranasal administration of sumatriptan for acute cluster attacks and bridging therapy with oral prednisolone until oral prophylactic therapy is effective. Finally, drugs for the preventive treatment of CH include verapamil, lithium, divalproex sodium (Depakote), gabapentin, and topiramate. Patients suffering from CH should first be encouraged to change potentially harmful lifestyle activities, including smoking or alcohol consumption, especially during cluster periods, to minimize CH episodes as much as possible before initiating acute or prophylactic drug treatment. Cluster headaches (CH) are categorized under trigeminal autonomic headaches. CH is generally treated through acute drug therapy and preventive medicine. These excruciating, unilateral headaches are usually accompanied by conjunctival injections and lacrimation, which involve bursts of moderate to severe burning, piercing, or throbbing pain and occur acutely, episodically, or chronically. Increasing controversy continues to challenge research on CH, especially prophylactic treatment, related to the intensities of CH pain and increased ethical concerns surrounding placebo treatments, making the design of randomized controlled trials difficult. Fortunately, as new technologies and genetic studies emerge, researchers better understand the etiology of CH, allowing for more specific targeted therapies. Therefore, this review discusses divalproex, valproate, and other traditional and novel prophylactic treatment options for CH, comparing their safety profiles, pharmacodynamics, pharmacokinetics, and limitations.

中文翻译：

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双丙戊酸、丙戊酸和开发丛集性头痛预防的治疗方案：临床实践注意事项

摘要

关于CH的预防性治疗，安慰剂对照研究很少，这意味着医生的大多数治疗建议仅限于开放观察性研究的结果。此外，由于我们对 CH 综合征的诊断不足，现有的有效疗法被认为没有得到充分利用。CH 发作的不同阶段有多种治疗方法，因此难以管理。一些治疗选择包括吸入 100% 氧气或皮下/鼻内给予舒马曲坦治疗急性丛集性发作，以及口服泼尼松龙桥接治疗，直至口服预防性治疗有效。最后，预防性治疗 CH 的药物包括维拉帕米、锂、双丙戊酸钠 (Depakote)、加巴喷丁和托吡酯。首先应鼓励 CH 患者改变潜在有害的生活方式，包括吸烟或饮酒，尤其是在聚集期，以在开始急性或预防性药物治疗之前尽可能减少 CH 发作。丛集性头痛 (CH) 属于三叉神经自主性头痛。CH 一般通过急性药物治疗和预防医学来治疗。这些令人难以忍受的单侧头痛通常伴有结膜充血和流泪，伴有中度至重度烧灼感、刺痛或搏动性疼痛，呈急性、阵发性或慢性发作。越来越多的争议继续对 CH 的研究提出挑战，特别是预防性治疗，与 CH 疼痛的强度有关，并且围绕安慰剂治疗的伦理问题日益增加，使得随机对照试验的设计变得困难。幸运的是，随着新技术和基因研究的出现，研究人员更好地了解了 CH 的病因，从而可以进行更具体的靶向治疗。因此，本综述讨论了双丙戊酸、丙戊酸以及其他传统和新型的 CH 预防性治疗方案，比较了它们的安全性、药效学、药代动力学和局限性。