Abstract：
Cluster headache, characterised by attacks of severe, recurrent, unilateral headache and ipsilateral cranial autonomic symptoms, remains a primary headache with an elusive pathophysiology. Recent advances have introduced effective treatments and broadened understanding of the clinical features of cluster headache. These features are similar in patients globally, but regional differences in prevalence and burden exist. International collaborations have led to identification of eight genetic loci associated with cluster headache. The pathophysiological mechanisms are still not fully understood but recent studies show that targeting the trigeminal autonomic reflex by neurostimulation, or targeting the neuropeptide calcitonin gene-related peptide (CGRP), might lessen the attack burden. The US Food and Drug Administration has approved galcanezumab, a monoclonal antibody targeting CGRP, as the first specific preventive treatment for episodic cluster headache. However, a preventive effect was not replicated in chronic cluster headache, and the European Medicines Agency did not approve galcanezumab, restricting its availability in Europe. Owing to the low prevalence of cluster headache, continued collaboration through multicentre clinical trials and data sharing will be imperative for further breakthroughs in understanding and management.
摘要：
丛集性头痛，以严重的攻击为特征，经常性,单侧头痛和同侧颅自主神经症状，仍然是原发性头痛，具有难以捉摸的病理生理学。最近的进展引入了有效的治疗方法，并扩大了对丛集性头痛临床特征的理解。这些特征在全球患者中相似，但患病率和负担存在地区差异。国际合作已导致与丛集性头痛相关的八个遗传基因座的鉴定。病理生理机制仍未完全了解，但最近的研究表明，通过神经刺激靶向三叉神经自主神经反射，或靶向神经肽降钙素基因相关肽（CGRP），可以减轻攻击负担。美国食品和药物管理局已经批准了galcanezumab，靶向CGRP的单克隆抗体，作为发作性丛集性头痛的第一个具体预防性治疗方法。然而,在慢性丛集性头痛中没有复制预防作用，欧洲药品管理局没有批准galcanezumab，限制其在欧洲的可用性。由于丛集性头痛的患病率较低，通过多中心临床试验和数据共享的持续合作对于理解和管理方面的进一步突破至关重要。
