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Therapie und Prophylaxe von Cluster-Kopfschmerzen und anderen trigemino-autonomen Kopfschmerzen

Überarbeitete Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft

Treatment and prophylaxis for cluster headaches and other trigeminal autonomic headaches

Revised recommendations of the German Migraine and Headache Society

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Zusammenfassung

Nach der neuen IHS-Klassifikation werden der episodische und chronische Cluster-Kopfschmerz, die episodisch und chronische paroxysmale Hemikranie und das SUNCT-Syndrom („short-lasting unilateral neuralgiform headache with conjunctival injection and tearing“) unter dem Begriff trigemino-autonome Kopfschmerzen (TAK) zusammengefasst. Sie unterscheiden sich in Dauer, Frequenz, Rhythmik und Intensität der Schmerzattacken. Autonome Begleitsymptome wie Lakrimation, konjunktivale Injektion, Rhinorrhö, nasale Kongestion und Lidschwellung treten mehr oder weniger stark ausgeprägt auf. Ein wesentliches weiteres Unterscheidungsmerkmal liegt in dem unterschiedlichen Ansprechen auf Indometacin. Grundsätzlich unterteilt sich die Therapie, ähnlich wie die der Migräne, in eine Akuttherapie und eine medikamentöse Prophylaxe. Aufgrund der relativen Kürze der Attacken ist jegliche Medikation in Tablettenform nicht wirksam genug, das größte Augenmerk liegt auf der Prophylaxe. Die zeitintensive Betreuung der Patienten erfordert eine individuell zugeschnittene Kombination der verschiedenen Therapieoptionen. Obwohl ausreichend gute vergleichende Studien rar sind, kann in der Praxis in der großen Mehrzahl der Fälle eine positive Beeinflussung der Schmerzattacken erreicht werden. Die vorliegenden Therapieempfehlungen stützen sich auf Kriterien der „evidence based medicine“ (EBM).

Abstract

Following the new IHS classification, cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) are included in the classification as trigeminal autonomic cephalgias (TAC). The similarities of these syndromes suggest a considerable shared pathophysiology. These syndromes have in common that they involve activation of trigeminovascular nociceptive pathways with reflex cranial autonomic activation. Clinically, this physiology predicts pain with some combination of lacrimation, conjunctival injection, nasal congestion, or eyelid edema. Broadly the management of TAC comprises acute and prophylactic treatment. Some types of trigeminal autonomic headaches such as paroxysmal hemicrania and hemicrania continua have, unlike cluster headaches, a very robust response to indometacin, leading to a consideration of indometacin-sensitive headaches. This review covers the clinical picture and therapeutic options. Although studies following the criteria of evidence-based medicine (EBM) are rare, most patients can be treated sufficiently.

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Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin:

A. May:

1.):

Bezahlung: BKR Regensburg

2.):

Grant: DFG, BMBF

3.):

Sponsoring klinischer Studien und persönliche Honorare für Vorträge: GSK (Glaxo), BayerVital, Astra-Zeneca, MSD, Berlin Chemie, Pfizer, Almirall, Bristol-Meyers-Squibb

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1.):

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2.):

Grants: Bertelsmann-Stiftung, IMF

3.):

Sponsoring klinischer und wissenschaftlicher Studien und persönliche Honorare für Vorträge und Beratertätigkeit in den letzten 2 Jahren: GSK, AstraZeneca, Berlin Chemie, Almirall, Pharm Allergan, Merz Pharmaceuticals, MSD, Institut du Recherche Pierre Fabre, Ipsen Pharma, Pfizer, Novartis, Boehringer Ingelheim, Janssen Cilag

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Bezahlung: Universität München

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Sponsoring: Sponsoring klinischer Studien und persönliche Honorare für Vorträge: GSK (Glaxo), BayerVital, Astra-Zeneca, MSD, Berlin Chemie, Pfizer, Almirall, Ipsen-Pharma

V. Pfaffenrath

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Bezahlung: selbstständig

2):

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HC. Diener

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Bezahlung: Land NRW über Universitätsklinikum Essen

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Sponsoring: Astra/Zeneca, Parke-Davis, Glaxo SmithKline (GSK), MSD, Pfizer, Lilly, Böhringer Ingelheim, Asta Medica, BASF Knoll, Bayer Vital, Bristol-Myers Squibb, Fresenius, Grünenthal, Janssen Cilag, 3 M Medica, Novartis, Pharmacia & Upjohn, Sanofi-Synthelabo, Schering, Allergan, Allmiral, Schaper and Brümmer, Johnson & Johnson, La Roche, Servier, Abbott

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Authors and Affiliations

  1. Neurologische Universitätsklinik Regensburg

    A. May

  2. Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster

    S. Evers

  3. Klinik und Poliklinik für Neurologie, Universität München

    A. Straube

  4. Neurologe, München

    V. Pfaffenrath

  5. Neurologische Universitätsklinik Essen

    H. C. Diener

  6. Neurologische Universitätsklinik, Martinistraße 52, 20246, Hamburg

    A. May

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May, A., Evers, S., Straube, A. et al. Therapie und Prophylaxe von Cluster-Kopfschmerzen und anderen trigemino-autonomen Kopfschmerzen. Schmerz 19, 225–241 (2005). https://doi.org/10.1007/s00482-005-0397-8

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