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Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter

Revidierte Empfehlungen der Gesellschaft für Neuropädiatrie (GNP) und der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG)

Treatment of idiopathic headache in childhood and adolescence

Revised recommendations of the Society for Neuropediatrics and the German Migraine and Headache Society

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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Nach den Richtlinien der „evidence-based medicine“ wurden die spezifischen kontrollierten Studien für die Behandlung von idiopathischen Kopfschmerzen im Kindes- und Jugendalter analysiert und in Therapieempfehlungen zusammengefasst. Mit der höchsten Evidenz wird für die Behandlung akuter Migräneattacken oder von Kopfschmerzen vom Spannungstyp Ibuprofen (10 mg pro kg Körpergewicht) empfohlen. Als Mittel der zweiten Wahl für alle Altersstufen gilt Paracetamol (15 mg/kg KG). Ab dem 12. Lebensjahr ist für Migräneattacken auch Sumatriptan Nasenspray (10–20 mg) Mittel der zweiten Wahl (im Einzelfall kann es auch bei jüngeren Kindern eingesetzt werden). Bei Versagen der Akutmedikamente der ersten und zweiten Wahl kann auf Substanzen der dritten Wahl wie Zolmitriptan 2,5 mg als Schmelztablette, Zolmitriptan 5 mg als Nasenspray, Rizatriptan 5–10 mg, Almotriptan 12,5 und Dihydroergotamin 20–40 µg/kg KG ausgewichen werden. Für die medikamentöse Prophylaxe der Migräne werden Magnesium, Betablocker (Propranolol oder Metoprolol) und Flunarizin empfohlen. Flunarizin ist auch prophylaktisches Mittel der ersten Wahl bei migräneähnlichen Syndromen. Für andere Kopfschmerzarten liegen keine kontrollierten Studien für das Kindesalter vor. In der nichtmedikamentösen Prophylaxe von Kopfschmerzen im Kindesalter werden mit höchster Evidenz Entspannungsverfahren (progressive Muskelrelaxation), Biofeedbackverfahren und kindgerechte kognitiv-verhaltensorientierte Therapieprogramme empfohlen.

Abstract

According to the principles of evidence-based medicine, controlled studies on the treatment of idiopathic headache in childhood and adolescence were analysed and compiled into treatment recommendations. For acute treatment of migraine attacks or tension-type headache, ibuprofen (10 mg/kg body weight) is most highly recommended. Drugs of second choice are acetaminophen (15 mg/kg body weight) for all ages and for migraine attacks only, intranasal sumatriptan (10–20 mg) for the age of 12  years and older, in isolated cases also below 12 years of age. If the first or second choice acute drugs are not effective alternative drugs of third choice are zolmitriptan 2.5 mg as melting tablet, intranasal zolmitriptan 5 mg, rizatriptan 5–10 mg, almotriptan 12.5 and dihydroergotamine 20–40 µg/kg body weight. For the prophylaxis of migraine, magnesium, betablockers (propranolol and metoprolol) and flunarizine are recommended. Flunarizine is also the drug of first choice for the prophylactic treatment of migraine-related disorders. No controlled studies are available on the treatment of further headache types in childhood. First line methods recommended for the non-drug prophylactic treatment of headache in childhood are progressive relaxation therapy, biofeedback procedures and specific cognitive-behavioral therapeutic schedules.

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  1. Bereich Neuropädiatrie, Zentrum für Kinder- und Jugendmedizin , Klinikum der Ruprecht-Karls-Universität, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland

    F. Ebinger

  2. Institut für Medizinische Psychologie, Medizinische Fakultät der Universität, Rostock, Deutschland

    P. Kropp

  3. Zentrum für Kinderschmerztherapie, Hamburg, Deutschland

    R. Pothmann

  4. Zentrum für Pädiatrische Neurologie und Entwicklungsneurologie, Dr. von Haunersches Kinderspital der Ludwig-Maximilians-Universität, München, Deutschland

    F. Heinen

  5. Klinik und Poliklinik für Neurologie, Klinikum der Westfälischen Wilhelms-Universität, Münster, Deutschland

    S. Evers

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  1. F. Ebinger
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  2. P. Kropp
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  3. R. Pothmann
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  5. S. Evers
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Evers S, Pothmann R, Überall M et al. (2001) Therapie idiopathischer Kopfschmerzen im Kindesalter. Nervenheilkunde 20: 306–315 und (2002) Schmerz 16: 48–56.

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Ebinger, F., Kropp, P., Pothmann, R. et al. Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 157, 599–610 (2009). https://doi.org/10.1007/s00112-009-2002-1

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