Zusammenfassung
In dieser Übersicht werden die neuesten Erkenntnisse zur Pathophysiologie, Akuttherapie
und Prophylaxe von Kopfschmerzen dargestellt. Für die familiär hemiplegische Migräne
wurde ein neuer Genlokus auf dem Chromosom 1 identifiziert, der eine Ionenpumpe in
der Zellmembran kodiert. Triptane sind heute die Substanzen der ersten Wahl zur Behandlung
schwerer Migräneattacken. In Studienpopulationen sind allerdings Analgetika wie Azetylsalizylsäure
oder nichtsteroidale Antirheumatika fast genauso wirksam wie Triptane. Neu bei den
Triptanen ist Zolmitriptan-Nasenspray, das rascher wirkt als die orale Applikation.
Frovatriptan hat eine begrenzte Wirksamkeit und eine niedrige Rate wiederkehrender
Kopfschmerzen. Neu untersucht in der Migräneprophylaxe sind retardierte Valproinsäure
und Topiramat. Der mögliche Nutzen von Botulinumtoxin ist nicht ausreichend belegt.
Zum ersten Mal wurde jetzt belegt, dass Metamizol bei der Therapie des episodischen
Spannungskopfschmerzes wirksam ist. In der Prophylaxe spielen trizyklische Antidepressiva
in Kombination mit Verhaltenstherapie weiterhin die wichtigste Rolle. Auch Triptane
können zu medikamentinduzierten Dauerkopfschmerzen führen. Dies geschieht mit Triptanen
rascher als mit Mutterkornalkaloiden. Der Entzug ist allerdings einfacher und rascher.
Abstract
This review summarizes recent new information about the pathophysiology, therapy and
prevention of headache. Familial hemiplegic migraine can be caused by a mutation on
chromosome 19. A new mutation, coding an ion channel pump, was recently identified
on chromosome 1. Triptans are the drugs of first choice in severe migraine attacks.
Up to now, clinical trials could, however, not show a clear superiority of triptans
over aspirin or non-steroidal anti-inflammatory drugs. A new application of zolmitriptan
is the nasal spray leading to a faster onset of efficacy than the oral application.
Frovatriptan has a limited efficacy but a low recurrence rate. New in migraine prophylaxis
are slow release valproic acid and topiramate. The benefit of local injections of
botulinum toxin is not proven for the prophylaxis of migraine or tension headache.
Metamizole (dipyrone) is effective in episodic tension headache. For the prevention
of chronic tension-type headache tricyclic antidepressants in combination with stress
management or muscle relaxation are most effective. Not only combination analgesics
and ergots can lead to medication overuse headache but also triptans. Triptans lead
to this headache after a shorter time interval than ergots. Withdrawal therapy is
easier with triptans than with analgesics or ergots.
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Prof. Dr. Hans-Christoph Diener
Klinik für Neurologie · Universität Essen
Hufelandstraße 55
45147 Essen
Email: h.diener@uni-essen.de
