Zusammenfassung
Die Kopfschmerzforschung und klinische Weiterbildung in Deutschland hatte ihren Beginn in den 1970er-Jahren und ist mit dem Engagement von D. Soyka verbunden. Dadurch wurde nicht nur die Gründung der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG) am 28.6.1979 in Erlangen ermöglicht, sondern letztlich auch die Gründung der International Headache Society (IHS) mit angestoßen. Letztere veröffentlichte dann 1988 die erste in der Praxis brauchbare und verbindliche Klassifikation von Kopfschmerzen, die sich im Weiteren als eine wesentliche Voraussetzung für die erfolgreiche Forschung auf dem Gebiet der Kopfschmerzen herausstellte. Aufbauend darauf konnten für alle Industrieländer Prävalenzzahlen erhoben werden, die zeigen, dass Kopfschmerzen mit einer 12-Monats-Prävalenz von etwa 60 % zu den absolut häufigsten Gesundheitsbeschwerden zählen. Grundlagenforschung zeigte, dass serotoninergen Mechanismen eine wesentliche Rolle bei der Schmerzentstehung zukommt. In Deutschland konnten verschiedene Gruppen zeigen, dass Hirnstammareale in der Pathophysiologie der Migräne eine wesentliche Rolle spielen. Verschiedene Arbeitsgruppen waren dann auch an der Entschlüsselung von molekularen Signalwegen in der Entstehung von Migräne und Clusterkopfschmerz, z. B. über das „calcitonin gene-related peptide“ (CGRP), beteiligt. Eine Besonderheit der Deutschen Versorgungslandschaft ist die Etablierung von integrierten Kopfschmerzzentren, die eine multimodale Therapie von chronisch erkrankten, schwer betroffenen Patienten ermöglichen. Diesen Erfolgen stehen aber konkrete Probleme gegenüber, die die Fortsetzung dieser erfolgreichen Arbeit gefährden. Neben einem Defizit in der universitären Verankerung der Kopfschmerzforschung finden sich auch zunehmend Defizite in der studentischen wie auch klinischen Lehre und Weiterbildung, was in Zukunft Defizite in der klinischen Versorgung erwarten lässt. Bedingt ist das Defizit letztlich auch durch eine finanzielle Unterausstattung der Forschung und klinischen Versorgung auf dem Gebiet der Kopfschmerzerkrankungen.
Abstract
The starting point for German headache research and clinical education was the engagement of D. Soyka in the 1970s, which enabled the foundation of the German Headache Society (DMKG) on 28 June 1979 and, some years later, the founding congress of the International Headache Society (IHS) in Munich 1982. As a result of these activities, in 1988 the first international classification of headache disorders was published. This classification was one of the major milestones in the development of basic as well as clinical headache research. In the following years, epidemiological studies all over the world showed a 1-year prevalence for headache of approximately 60 %, making headaches one of the most frequent medical complaints. Basic research showed an involvement of serotonergic mechanisms in migraine pain and triptans were one of the first drugs designed to influence these mechanisms. Functional brain imaging studies in migraine patients further showed a cyclic modulation of the activity of brainstem areas independent of the current pain state. Various research groups were involved in the clarification of the role of calcitonin gene-related peptide (CGRP) in migraine and cluster headache. A specific development in the German headache scene is the establishment of integrated headache centers and reflects the primarily multimodal treatment approach in Germany which contrasts with the settings in other countries. These successful developments are increasingly being undermined by the fact that the low financial support of headache research, for example, by the German science council is causing a decreasing interest in headache research, with the consequence that the clinical education of students as well as young medical doctors shows increasing deficits. The consequence for the future will be a deficit in the clinical care of the population.
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Straube, A., Gaul, C. Kopfschmerz. Schmerz 29, 510–515 (2015). https://doi.org/10.1007/s00482-015-0040-2
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DOI: https://doi.org/10.1007/s00482-015-0040-2