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Neurologie up2date 2018; 1(01): 107-132
DOI: 10.1055/a-0654-1324
DOI: 10.1055/a-0654-1324
Kopfschmerz und andere Schmerzsyndrome
Kopfschmerzen – Update 2018
Further Information
Publication History
Publication Date:
04 October 2018 (online)
Die Kopfschmerzforschung macht Fortschritte. Dies zeigt sich an der großen Zahl von Publikationen zur Epidemiologie, Pathophysiologie, Akuttherapie und Prophylaxe von Kopfschmerzen. Die vorliegende Übersicht referiert die wichtigsten Studien zu Kopfschmerzen aus dem Zeitraum 2017 bis Juni 2018. Die Auswahl der referierten Studien ist subjektiv und erfolgte nach der Einschätzung der Autoren.
Kernaussagen
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Epidemiologische Studien belegen an immer größeren Populationen einen eindeutigen Zusammenhang zwischen Migräne und vaskulären Krankheiten. Pathophysiologische Studien zeigen eine bedeutende Rolle des Hypothalamus bei der Generierung von Migräneattacken. Dabei scheint Glutamat eine wichtige Rolle zu spielen. Neue MRT-Studien mit Kontrastmittel unterstützen die Annahme, dass die Blut-Hirn-Schranke während Migräneattacken intakt bleibt.
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Trotz statistischer Unterschiede in der Wirksamkeit und Verträglichkeit verschiedener Triptane in Metaanalysen bleibt die Auswahl eines Triptans individuell. Verfahren der Neurostimulation finden jetzt auch Eingang in die Akuttherapie der Migräne. Monoklonale humanisierte Antikörper gegen CGRP (Calcitonin Gene-related Peptide) und ein vollhumaner Antikörper gegen den CGRP-Rezeptor sind sowohl in der Prophylaxe der episodischen wie der chronischen Migräne wirksam. Sie zeichnen sich durch eine gute Verträglichkeit aus. Langzeitdaten zur Sicherheit liegen noch nicht vor.
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Eine aktuelle Metaanalyse zum Einsatz von trizyklischen Antidepressiva beim Kopfschmerz vom Spannungstyp belegt die Wirksamkeit im Vergleich zu Placebo und die Überlegenheit verglichen mit SSRI (selektive Serotonin-Reuptake-Inhibitoren).
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Elektronische Tagebücher können beim Kopfschmerz bei Übergebrauch von Medikamenten die Rückfallwahrscheinlichkeit nach Medikamentenpause reduzieren.
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Bei Patienten mit chronischem Clusterkopfschmerz kann eine erfolgreiche Attackentherapie mit der transkutanen Stimulation des N. vagus erfolgen.
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Beim schlafgebundenen Kopfschmerz spielt die Melatoninausschüttung wohl keine wesentliche Rolle.
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Bei der Trigeminusneuralgie besteht eine erhebliche Komorbidität mit Depressionen und Angsterkrankungen.
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