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Therapie des trigeminoautonomen Kopfschmerzes

Therapy of trigeminal autonomic headaches

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die trigeminoautonomen Kopfschmerzen (TAK) zeichnen sich durch starke streng einseitige Kopfschmerzen mit Betonung in der Stirn-Schläfen-Region und/oder periorbital in Verbindung mit ipsilateral dazu auftretenden kraniellen autonomen Symptomen wie Lakrimation, konjunktivaler Injektion, Rhinorrhö, nasaler Kongestion und einer Agitiertheit bzw. Unruhe aus. Sie unterscheiden sich untereinander durch die unterschiedliche Zeitdauer der Attacken. Während beim SUNCT-Syndrom (Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) Attacken 5 s bis 10 min andauern, beträgt die übliche Dauer bei der paroxysmalen Hemikranie 2–30 min und beim Clusterkopfschmerz 15–180 min. Die Hemicrania continua stellt eine Dauervariante der TAKs dar. Auch hinsichtlich der Therapie bestehen deutliche Unterschiede: Beim SUNCT-Syndrom steht mit Lamotrigin und bei der paroxysmalen Hemikranie mit Indometacin die prophylaktische Behandlung im Vordergrund. Beim Clusterkopfschmerz stehen als Akutmedikation Sauerstoff (100 %, inhaliert über Maske) sowie Sumatriptan s.c. und intranasales Zolmitriptan zur Verfügung, als Prophylaxe werden Methysergid und Cortison für kürzere Zeiträume bzw. überbrückend sowie Verapamil für längere Einnahmedauern als Mittel der 1. Wahl empfohlen, Lithiumcarbonat und Topiramat als Mittel der 2. Wahl. Indometacin stellt auch für die Hemicrania continua die Therapie der 1. Wahl dar. Gerade für therapierefraktäre Verläufe des chronischen Clusterkopfschmerzes werden zunehmend neuromodulierende Verfahren wie die Stimulation des N. occipitalis oder des Ganglion sphenopalatinum eingesetzt.

Abstract

Trigeminal autonomic cephalgias (TAC) are characterized by severe and strictly unilateral headaches with a frontotemporal and periorbital preponderance in combination with ipsilateral cranial autonomic symptoms, such as lacrimation, conjunctival injection, rhinorrhea, nasal congestion, and restlessness or agitation. One main differentiating factor is the duration of painful attacks. While attacks typically last 5 s to 10 min in SUNCT syndrome (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), paroxysmal hemicrania lasts 2–30 min and cluster headaches 15–180 min. Hemicrania continua represents a continuous TAC variant. From a therapeutic view, TACs differ substantially. Lamotrigine is used as first-choice prevention in SUNCT syndrome and indometacin in paroxysmal hemicrania. For cluster headaches, acute therapy with inhaled pure oxygen and fast-acting triptans (sumatriptan s.c. and intranasal zolmitriptan) is equally important to short-term preventive therapy with methysergide and cortisone and long-term prophylactic treatment comprising verapamil as drug of first choice and lithium carbonate and topiramate as drugs of second choice. In refractory cases of chronic cluster headache, neuromodulatory approaches such as occipital nerve stimulation and sphenopalatine ganglion stimulation are increasingly applied.

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  1. Institut für Systemische Neurowissenschaften Kopfschmerzambulanz, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 22529, Hamburg, Deutschland

    Tim Patrick Jürgens

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Correspondence to Tim Patrick Jürgens.

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Jürgens, T. Therapie des trigeminoautonomen Kopfschmerzes. Bundesgesundheitsbl. 57, 983–995 (2014). https://doi.org/10.1007/s00103-014-2003-7

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