Abstract：
Cluster headache (CH) is characterized by severe unilateral pain ranging from the orbital to the temporal regions with ipsilateral autonomic manifestations. Although most patients respond to drugs or oxygen inhalation, some do not. In this case report, we introduce sympathetic nerve entrapment point injection (SNEPI), a new adjuvant treatment for CH.
We introduce two CH patients who did not respond well to pharmacological treatment or 100% oxygen inhalation, but who improved after SNEPI. Patient 1, a 42-year-old man, visited the Emergency Department (ED) with severe periorbital right frontal headache accompanied by ipsilateral rhinorrhea, conjunctival injection, and eyelid edema. The symptoms did not fully respond to drugs or oxygen inhalation, but improved after SNEPI into the tender point of the splenius capitis (SC) muscle; there was no further pain for 1 month thereafter. Patient 2, a 26-year-old woman, presented to the ED complaining of severe headache in the right supraorbital-temporal-occipital region with ipsilateral lacrimation and conjunctival congestion. The patient was taking various drugs for CH, but there was no improvement; the symptoms improved dramatically after SNEPI into the tender points of the SC and paraspinal deep muscles (levels T1-2), and the pain was well managed with reduced drug doses for 3 months. Why Should an Emergency Physician Be Aware of This? CH can cause severe acute pain, and sometimes pharmacological treatment or oxygen inhalation is not effective. SNEPI, which is inexpensive and can be easily performed, may be considered as an adjuvant treatment for intractable CH in the ED.
We introduce two CH patients who did not respond well to pharmacological treatment or 100% oxygen inhalation, but who improved after SNEPI. Patient 1, a 42-year-old man, visited the Emergency Department (ED) with severe periorbital right frontal headache accompanied by ipsilateral rhinorrhea, conjunctival injection, and eyelid edema. The symptoms did not fully respond to drugs or oxygen inhalation, but improved after SNEPI into the tender point of the splenius capitis (SC) muscle; there was no further pain for 1 month thereafter. Patient 2, a 26-year-old woman, presented to the ED complaining of severe headache in the right supraorbital-temporal-occipital region with ipsilateral lacrimation and conjunctival congestion. The patient was taking various drugs for CH, but there was no improvement; the symptoms improved dramatically after SNEPI into the tender points of the SC and paraspinal deep muscles (levels T1-2), and the pain was well managed with reduced drug doses for 3 months. Why Should an Emergency Physician Be Aware of This? CH can cause severe acute pain, and sometimes pharmacological treatment or oxygen inhalation is not effective. SNEPI, which is inexpensive and can be easily performed, may be considered as an adjuvant treatment for intractable CH in the ED.
摘要：
背景：丛集性头痛（CH）的特征是严重的单侧疼痛，从眼眶到颞区均有同侧自主神经表现。尽管大多数患者对药物或氧气吸入有反应，有些不。在这个案例报告中,我们介绍交感神经卡压点注射（SNEPI），一种新的CH辅助治疗。
方法：我们介绍了两名对药物治疗或100％吸氧反应不佳的CH患者，但是在SNEPI之后谁有所改善。病人1，一个42岁的男人，就诊于急诊科（ED），患有严重的眶周右额头痛并伴有同侧鼻漏，结膜注射,和眼睑水肿。症状对药物或氧气吸入没有完全反应，但是在SNEPI进入脾性腹炎（SC）肌肉的压痛点后有所改善；此后1个月没有进一步的疼痛。病人2，一个26岁的女人，ED主诉右眶上-颞-枕区严重头痛伴同侧流泪和结膜充血。患者正在服用各种药物治疗CH，但是没有改善；SNEPI进入SC和椎旁深层肌肉的压痛点后症状显着改善（T1-2级），通过减少药物剂量3个月，疼痛得到了很好的控制。为什么急诊医师应该意识到这一点？CH会导致严重的急性疼痛，有时药物治疗或吸氧无效。SNEPI,这是便宜的，可以很容易地执行，可能被认为是ED中难治性CH的辅助治疗。
方法：我们介绍了两名对药物治疗或100％吸氧反应不佳的CH患者，但是在SNEPI之后谁有所改善。病人1，一个42岁的男人，就诊于急诊科（ED），患有严重的眶周右额头痛并伴有同侧鼻漏，结膜注射,和眼睑水肿。症状对药物或氧气吸入没有完全反应，但是在SNEPI进入脾性腹炎（SC）肌肉的压痛点后有所改善；此后1个月没有进一步的疼痛。病人2，一个26岁的女人，ED主诉右眶上-颞-枕区严重头痛伴同侧流泪和结膜充血。患者正在服用各种药物治疗CH，但是没有改善；SNEPI进入SC和椎旁深层肌肉的压痛点后症状显着改善（T1-2级），通过减少药物剂量3个月，疼痛得到了很好的控制。为什么急诊医师应该意识到这一点？CH会导致严重的急性疼痛，有时药物治疗或吸氧无效。SNEPI,这是便宜的，可以很容易地执行，可能被认为是ED中难治性CH的辅助治疗。
