Neues zu klinischen Aspekten und der Pathophysiologie chronischer Kopfschmerzen

Zusammenfassung

Chronische Kopfschmerzen, insbesondere chronische Migräne, chronischer Kopfschmerz vom Spannungstyp und Kopfschmerz bei Medikamentenübergebrauch, stellen ein zunehmendes Gesundheitsproblem in unserer Gesellschaft dar. Risikofaktoren für die Entstehung sind v. a. die missbräuchliche Einnahme von Schmerzmitteln, Triptanen und Ergotaminen. Daneben begünstigen auch die hohe Frequenz des primären episodischen Kopfschmerzes, psychiatrische Komorbiditäten wie Depressionen und Angststörungen, niedriger sozialer Status, Adipositas aber auch die Einnahme von Koffein ihr Auftreten. Die genauen pathophysiologischen Entstehungsmechanismen chronischer Kopfschmerzen liegen dabei noch größtenteils im Dunkeln. Erste Erklärungsansätze beinhalten genetische Mutationen, Modifikation der trigeminalen Schmerzverarbeitung, pharmakologische sowie funktionelle und strukturelle zerebrale Veränderungen. Auch ein erhöhter Liquordruck wird als mögliche kausale Ursache chronischer Kopfschmerzen diskutiert. Dieser Artikel will die bisher bekannten pathophysiologischen Mechanismen chronischer Kopfschmerzerkrankungen beleuchten und für die weitere Therapie hoffnungsvolle Behandlungsansätze aufzeigen.

Abstract

Chronic headache, especially chronic migraine, chronic tension-type headache and medication-overuse headache, is a growing health problem in our society. Risk factors for its development are mainly abusive intake of analgesics, triptans and ergotamines. Additionally, the high frequency of the primary headache, psychiatric comorbidities such as depression and anxiety disorder, low socioeconomic status, obesity as well as caffeine intake all promote the occurrence of chronic headache. The detailed pathophysiological mechanisms that lead to the development of chronic headache are still unresolved. Initial approaches for explanation favour genetic mutations, modification of the trigeminal nociceptive system, pharmacological as well as functional and structural cerebral changes. Moreover, an increased liquor pressure is also discussed as a probable cause of chronic headache. This article illustrates the known pathophysiological mechanisms of chronic headache and tries to identify promising approaches for new therapies.

Schlüsselwörter

chronische Kopfschmerzen - Pathophysiologie - Medikamentenübergebrauch - Liquordruck

Keywords

chronic headache - pathophysiology - medication overuse - liquor pressure

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