Neues bei Kopfschmerzen 2008

Zusammenfassung

Der Terminus chronische Migräne kann sich zunehmend als eigene Kopfschmerzentität ohne Vorliegen eines medikamenteninduzierten Kopfschmerzes auch international durchsetzen. Obwohl die Lebenszeitprävalenz einer vestibulären Migräne 1 % beträgt, wird diese Diagnose auch von Kopfschmerzexperten selten gestellt und demzufolge die Symptome falsch behandelt. Weitere prospektive Studien konnten nach Patientenangaben Trigger und Prodromi der Migräne identifizieren. Tiermodelle der kortikalen Spreading Depression etablieren sich zunehmend, um insbesondere die Migräneaura besser zu verstehen. Die Kombinationstherapie aus Sumatriptan und Naproxen ist wirksamer als die Einzelsubstanzen. Aktuelle Studien zu Topiramat belegen eine Wirksamkeit bei chronischer Migräne und chronischem Spannungskopfschmerz sowie medikamenteninduziertem Kopfschmerz. Es bestehen deutliche Hinweise auf eine lang anhaltende Reduktion der Migränetage auch nach Absetzen einer 6-monatigen Prophylaxe mit Topiramat. Zur Kurzzeitprophylaxe bei menstrueller Migräne konnte in kontrollierten Studien weder für Östrogenpräparate, NSAR noch Triptane ein nachhaltiger Effekt belegt werden. Zur Prophylaxe des chronischen Spannungskopfschmerzes zeigte auch Venlafaxin eine Wirksamkeit. Als Alternative zur Tiefenhirnstimulation kann bei Patienten mit therapierefraktärem Clusterkopfschmerz die bilaterale Stimulation des N. occipitalis betrachtet werden. Die Diagnose eines Thunderclap Headache ist erst nach Ausschluss sämtlicher symptomatischer Ursachen, insbesondere einer Subarachnoidalblutug, zu stellen. Bei einem Teil der Patienten liegt eine MR-angiografisch nachweisbare reversible zerebrale Vasokonstriktion vor.

Abstract

Chronic migraine without medication overuse is now widely accepted as a unique headache entity. Although the lifetime prevalence of migrainous vertigo is 1 %, it is most likely that most patients are not correctly diagnosed or treated. Further prospective studies have revealed triggers and premonitory symptoms signalling migraine attacks. Animal models of cortical spreading depression are being increasingly established to help understand migraine aura and headache. The combination of sumatriptan and naproxen is more effective in comparision to each of the substances alone. Recent trials have shown the efficiacy of topiramate in the treatment of medication overuse headache, chronic migraine and tension-type headache. There is further evidence for a cessation of migraine preventive therapy with topiramate after six months regarding a long-term benefit. However, there is no evidence from randomised trials for short-term prophylaxis of menstrual migraine with estrogen, NSAIDs or triptans. Venlaflaxine is effective for preventive therapy of chronic tension-type headache. Bilateral stimulation of the occipital nerve might be an option for patients suffering from refractory chronic cluster headache instead of deep brain stimulation. Reversible cerebral vasoconstriction may represent a frequent cause of thunderclap headache.

Schlüsselwörter

Kopfschmerz - Migräne - spreading depression - Prophylaxe

Key words

headache - migraine - spreading depression - prophylaxis

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