medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-19-100-108medsovet-6538Research ArticleНЕРВНО-ПСИХИЧЕСКИЕ РАССТРОЙСТВАNEUROPSYCHIATRIC DISORDERSКоррекция нарушений сна у пациентов с тригеминальными вегетативными цефалгиямиSleep disturbance management in patients with trigeminal autonomic cephalalgiashttps://orcid.org/0000-0002-7811-0416ВащенкоН. В.VashchenkoN. V.

Ващенко Нина Владимировна, аспирант кафедры неврологии и нейрохирургии; невролог

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

121467, Россия, Москва, ул. Молодогвардейская, д. 2, корп. 1

Nina V. Vashchenko, Postgraduate Student, Neurology and Neurosurgery department; Neurologist

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia

2, Bldg. 1, Molodogvardeyskaya St., Moscow, 121467, Russia

nina.vashch@gmail.comhttps://orcid.org/0000-0002-7791-3081УжаховА. М.UzhakhovA. M.

Ужахов Алихан Магомедович, аспирант лаборатории фундаментальных и прикладных проблем боли; невролог

121467, Россия, Москва, ул. Молодогвардейская, д. 2, корп. 1

125315, Россия, Москва, ул. Балтийская, д. 8

Аlikhan М. Uzhakhov, Neurologist; Postgraduate Student, Laboratory of Fundamental and Applied Problems of Pain

2, Bldg. 1, Molodogvardeyskaya St., Moscow, 121467, Russia

8, Baltiyskaya St., Moscow, 125315, Russia

alihan.uzhakhoff@gmail.comhttps://orcid.org/0000-0002-3713-4884АзимоваЮ. Э.AzimovaJu. E.

Азимова Юлия Эдвардовна, д.м.н., невролог, Университетская клиника головной боли; ведущий научный сотрудник лаборатории фундаментальных и прикладных проблем боли

121467, Россия, Москва, ул. Молодогвардейская, д. 2, корп. 1

125315, Россия, Москва, ул. Балтийская, д. 8

Julia Е. Azimova, Dr. Sci. (Med.), Neurologist; Leading Researcher, Laboratory of Fundamental and Applied Problems of Pain

2, Bldg. 1, Molodogvardeyskaya St., Moscow, 121467, Russia

8, Baltiyskaya St., Moscow, 125315, Russia

azimova.j@mail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Университетская клиника головной болиРоссияSechenov First Moscow State Medical University (Sechenov University); University Headache ClinicRussian FederationУниверситетская клиника головной боли; Научно-исследовательский институт общей патологии и патофизиологииРоссияUniversity Headache Clinic; Institute of General Pathology and PathophysiologyRussian Federation202130112021019100108Copyright © Ващенко Н.В., Ужахов А.М., Азимова Ю.Э., 20212021Ващенко Н.В., Ужахов А.М., Азимова Ю.Э.Vashchenko N.V., Uzhakhov A.M., Azimova J.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6538

Тригеминальные вегетативные цефалгии (ТВЦ) редко встречаются в популяции, однако это наиболее интенсивные первичные головные боли, которые резко ограничивают работоспособность и социальную активность пациентов. В данной статье представлены современная классификация ТВЦ на основании международной классификации головной боли 3-го пересмотра и ключевые отличия между видами ТВЦ, показаны патофизиологические механизмы развития приступов – роль тригеминоваскулярной системы, вегетативной нервной системы, гипоталамуса и блуждающего нерва и их связь с циклами сна и бодрствования. Также рассмотрены нарушения сна, которые могут возникать у пациентов с ТВЦ, усугубляя течение заболевания, и роль мелатонина, гипоталамуса и супрахиазматического ядра в этих изменениях. В дополнение к этому описана современная терапия кластерной головной боли, к которой относятся терапия приступа (применение триптанов и высокопоточного кислорода) и профилактическая терапия (верапамил, литий, топирамат), рекомендации по времени прекращения профилактической терапии. Также приведены имеющиеся данные по мелатонину и новым методам лечения, таким как моноклональные антитела к кальцитонин-ген-связанному пептиду (CGRP) и нейромодуляция, включающая в себя две наиболее перспективные методики: неинвазивную стимуляцию блуждающего нерва и микростимуляцию крылонебного ганглия. В заключение представлен клинический случай пациента с хронической кластерной головной болью на профилактической терапии верапамилом, которому дополнительно был назначен препарат мелатонина, на фоне чего интенсивность боли и частота приступов значительно снизились, что существенно улучшило качество жизни пациента.

Trigeminal autonomic cephalalgias (TACs) are rare but are the most intense primary headaches that severely limit patients’ ability to work and be socially active. This article reviews the modern classification of TACs, based on the International Classification of Headache Disorders-3, and the key differences between TAC types, as well as the pathophysiological mechanisms – the role of the trigeminovascular system, autonomic nervous system, hypothalamus and vagus nerve – and their relation to circadian rhythms. The sleep disturbances that can occur in patients with TACs, exacerbating the course of the disease, and the role of melatonin, hypothalamus and suprachiasmatic nucleus in these conditions are also discussed. In addition, current therapies for cluster headache are described, which include acute therapy and prophylactic therapy, with recommendations regarding the timing of prophylactic therapy discontinuation. The review also includes the available data on melatonin as well as new therapies such as CGRP monoclonal antibodies and neuromodulation, which includes the two most promising techniques: non-invasive vagus nerve stimulation and sphenopalatine ganglion microstimulation. Furthermore, the authors present the clinical case of a patient with chronic cluster headache, which was significantly reduced in frequency and intensity when melatonin was added to the therapy.

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The authors declare that there are no conflicts of interest present.