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Nervenheilkunde 2011; 30(01/02): 47-58
DOI: 10.1055/s-0038-1627764
DOI: 10.1055/s-0038-1627764
Therapieempfehlungen der DMKG
Einsatz neuromodulierender Verfahren bei primären Kopfschmerzen
Therapieempfehlungen der Deutschen Migräne- und KopfschmerzgesellschaftNeuromodulation in primary headacheTreatment recommendation of the German Migraine and Headache SocietyFurther Information
Publication History
Eingegangen am:
01 December 2010
angenommen am:
07 December 2010
Publication Date:
23 January 2018 (online)
Zusammenfassung
Neuromodulierende Verfahren haben die Behandlung von Patienten mit therapierefraktären primären Kopfschmerzen im letzten Jahrzehnt revolutioniert. Unterschieden werden die invasiven (periphere Nervenstimulation, vor allem des N. okzipitalis major, Vagusnervstimulation, zervikale Rückenmarkstimulation und hypothalamische Tiefenhirnstimulation) von den nicht invasiven Verfahren (repetitive transkranielle Magnetstimulation, transkutane elektrische Nervenstimulation und transkranielle Magnetstimulation). In diesen Therapieempfehlungen werden zunächst Kriterien für therapierefraktäre Verläufe primärer Kopfschmerzen und darauf basierende Ein-und Ausschlusskriterien für eine Neuromodulation definiert. Aus dem Bereich der invasiven Verfahren ist die subkutane Stimulation des N. okzipitalis major bei chronischem Clusterkopfschmerz sowie eingeschränkt bei Hemicrania continua, Okzipitalisneuralgie und chronischer Migräne zu empfehlen. Alternativ ist bei chronischem Clusterkopfschmerz und SUNCT-Syndrom auch die hypothalamische Tiefenhirnstimulation wirksam. Für andere Kopfschmerzarten und Stimulationsverfahren fehlen derzeit überzeugende Daten. Der alleinige oder additive Einsatz nicht invasiver Verfahren ist nicht gut belegt.
Summary
Neuromodulatory techniques have revolutionized the treatment of patients with refractory primary headaches. They can be distinguished between invasive (peripheral nerve stimulation, particularly of the greater occipital nerve, vagus nerve stimulation, cervical spinal cord stimulation and hypothalamic deep brain stimulation) and non-invasive procedures (transcutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation and transcranial direct current stimulation). Criteria for refractory headaches as well as in-and exclusion criteria for neuromodulatory approaches are presented in these treatment recommendations. Occipital nerve stimulation is recommended for patients with chronic cluster headache and to a limited extent in hemicrania continua, occipital neuralgia and chronic migraine.Alternatively, hypothalamic deep brain stimulation is effective in chronic cluster headache and SUNCT syndrome. No clear recommendation can be given for the primary headaches and other neuromodulatory techniques. There is poor evidence for the isolated or combined use of non-invasive techniques.
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