Abstract：
The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated Taiwan\'s guidelines for the acute and preventive treatment of cluster headaches on the basis of the principles of evidence-based medicine. The subcommittee assessed the quality of clinical trials and levels of evidence and referred to the treatment guidelines of other countries. Over the course of several panel discussions, the subcommittee members reached a consensus regarding the major roles of, recommended levels of, clinical efficacy of, adverse events in, and clinical precautions for the acute and preventive treatment of cluster headaches. Thus, the subcommittee updated the previous version of the guidelines published in 2011. Most cluster headaches occurring in Taiwan are episodic, and very few patients develop chronic cluster headaches. Cluster headaches cause extreme pain over a short period and are accompanied by ipsilateral autonomic symptoms; therefore, immediate treatment can provide considerable relief. Treatment options can be categorized into acute and preventive types. Among the treatment methods currently available in Taiwan for cluster headaches, high-flow pure oxygen inhalation has demonstrated the best evidence and effectiveness for acute attacks, followed by triptan nasal spray; therefore, these are recommended as first-line treatments. Oral steroids and suboccipital steroid injections can be used as transitional preventative treatments. Verapamil is recommended as a first-line treatment for maintenance prophylaxis. Drugs such as lithium, topiramate, and calcitonin gene-related peptide (CGRP) monoclonal antibodies are recommended as secondline treatments. Noninvasive vagus nerve stimulation is the recommended instrumental therapy. The effectiveness of surgical treatment, such as sphenopalatine ganglion stimulation, is supported by a high level of evidence; nevertheless, because few patients have chronic cluster headaches in Taiwan, no clinical records are available for use as a reference. Transitional prophylaxis and maintenance prophylaxis can be used simultaneously according to the individual condition of the patient, and the transitional prophylaxis can be gradually discontinued once the maintenance prophylaxis takes effect. Steroids should not be used for more than 2 weeks as transitional prophylaxis. Maintenance prophylaxis should be administered until the end of the bout period (no attacks for 2 weeks) and then gradually tapered off. Key words: cluster headaches, oxygen therapy, triptans, steroids, CGRP monoclonal antibodies, noninvasive vagus nerve stimulation.
摘要：
台湾头痛学会治疗指南小组委员会根据循证医学原则评估了台湾丛集性头痛的急性和预防性治疗指南。小组委员会评估了临床试验的质量和证据水平，并参考了其他国家的治疗指南。在几次小组讨论过程中，小组委员会成员就以下方面的主要作用达成共识，建议的水平，临床疗效,不良事件，以及丛集性头痛的急性和预防性治疗的临床预防措施。因此，小组委员会更新了2011年发布的指南的先前版本。台湾发生的大多数丛集性头痛都是偶发性的，很少有患者会出现慢性丛集性头痛。丛集性头痛在短时间内引起极度疼痛，并伴有同侧自主神经症状；因此，立即治疗可以提供相当大的缓解。治疗选择可分为急性和预防类型。在台湾目前可用的丛集性头痛的治疗方法中，高流量纯氧吸入已证明了急性发作的最佳证据和有效性，其次是曲坦鼻喷雾剂；因此，这些建议作为一线治疗。口服类固醇和枕下类固醇注射可用作过渡性预防性治疗。维拉帕米被推荐作为维持预防的一线治疗。锂等药物，托吡酯,和降钙素基因相关肽（CGRP）单克隆抗体被推荐作为二线治疗。非侵入性迷走神经刺激是推荐的仪器疗法。手术治疗的有效性，如蝶腭神经节刺激，得到了大量证据的支持；尽管如此，因为在台湾很少有病人有慢性丛集性头痛,没有临床记录可供参考.根据患者的个人情况，可以同时使用过渡性预防和维持性预防，一旦维持预防生效，过渡预防可以逐渐停止。作为过渡性预防，类固醇的使用时间不应超过2周。应进行维持预防，直到回合结束（2周没有发作），然后逐渐逐渐减少。关键词：丛集性头痛，氧疗,Triptans,类固醇,CGRP单克隆抗体,无创性迷走神经刺激.
