Medikamentöse Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter

S. Evers

doi:10.1055/s-0038-1627612

Nervenheilkunde, Table of Contents

Nervenheilkunde 2015; 34(08): 611-619
DOI: 10.1055/s-0038-1627612

Kopfschmerzen

Schattauer GmbH

Medikamentöse Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter

Drug treatment of idiopathic headache disorders in childhood and adolescence

Authors

S. Evers

¹Klinik für Neurologie, Krankenhaus Lindenbrunn, Coppenbrügge

Abstract

Zusammenfassung

Nach den Richtlinien der evidenzbasierten Medizin sind die spezifischen kontrollierten Studien für die Behandlung von idiopathischen Kopfschmerzen im Kindes- und Jugendalter analysiert worden. Mit der höchsten Evidenz wird für die Behandlung akuter Migräneattacken oder von Kopfschmerzen vom Spannungstyp Ibuprofen (10 mg pro kg Körpergewicht) empfohlen. Als Mittel der zweiten Wahl wird für alle Altersstufen Paracetamol (15 mg pro kg Körpergewicht) empfohlen, ab dem 12. Lebensjahr sind für Migräneattacken auch Sumatriptan Nasenspray (10 mg) und Zolmitriptan Nasenspray (5 mg) Mittel der zweiten Wahl (im Einzelfall auch bei jüngeren Kindern). Bei Versagen der Akutmedikamente der ersten und zweiten Wahl werden als Ausweichsubstanzen orale Triptane empfohlen. Für die medikamentöse Prophylaxe der Migräne zeigen Flunarizin und Topiramat die beste Evidenz, aber auch viele Nebenwirkungen. Außerdem werden Magnesium und Betablocker empfohlen. Flunarizin ist auch prophylaktisches Mittel der ersten Wahl bei migräneähnlichen Syndromen. Für andere Kopfschmerzarten liegen keine kontrollierten Therapiestudien für das Kindes- und Jugendalter vor.

Summary

According to the principles of evidencebased medicine, the controlled studies on the treatment of idiopathic headache in childhood have been analysed. For the acute treatment of migraine attacks or tensiontype headache, ibuprofen (10 mg per kg body weight) is recommended with highest evidence. Drugs of second choice are acetaminophen (15 mg per kg body weight) for all ages and, for migraine attacks only, intranasal sumatriptan (10 mg) or intranasal zolmitriptan (5 mg) for the age of 12 and older, in single cases also in the age below 12. If the acute drugs of first or second choice are not efficacious, alternative drugs are oral triptans. For the prophylaxis of migraine, flunarizine and topiramate show the highest evidence of efficacy but also several side effects. Magnesium and betablockers are recommended as well. Flunarizine is the drug of first choice in the treatment of migraine-related disorders. No controlled studies are available for the treatment of further headache types.

Schlüsselwörter

Kindes und Jugendalter - Migräne - Kopfschmerz vom Spannungstyp

Keywords

Childhood - adolescence - migraine - tensiontype headache

Full Text

References

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