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Innervation extrakranialer Gewebe durch Kollateralen von Hirnhautafferenzen

Neue Einsichten in die Entstehung und Therapie von Kopfschmerzen

Innervation of extracranial tissues through collaterals of meningeal afferents

New insights into the generation and therapy of headaches

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Zusammenfassung

Die Dura mater encephali und große zerebrale Arterien gelten als die entscheidenden Strukturen, von denen Kopfschmerzen ausgehen, da ihre Reizung ausschließlich Kopfschmerzempfindungen hervorruft. Inwieweit auch extrakraniale Strukturen wie die Kopf- und Halsmuskulatur mit ihren Triggerpunkten daran beteiligt sind, wird immer wieder kritisch diskutiert. Als Erklärung für den Einfluss der extrakranialen nozizeptiven Vorgänge auf das Kopfschmerzgeschehen wird vor allem die konvergente afferente Innervation auf der Ebene der sekundären Neurone im trigemino-zervikalen Hirnstammkomplex genannt. Neue strukturelle und funktionelle Untersuchungen, insbesondere sogenannte Tracingexperimente bei Nagern und am Menschen, weisen aber deutlich darauf hin, dass Nervenfasern der Dura mater mit kollateralen Verzweigungen durch Suturen und Venenkanäle den Schädelknochen verlassen und Teile des äußeren Periost sowie tiefe Schichten der Kopfmuskulatur innervieren können. Bei noxischer Stimulation dieser extrakranialen Strukturen wird die Erregung auch in die meningealen Äste der afferenten Fasern fortgeleitet, wodurch Neuropeptide freigesetzt und die Hirnhautdurchblutung gesteigert werden können. Der Nachweis solcher extrakranialen Kollateralen meningealer Nervenfasern führt zu einer veränderten Sicht auf Vorgänge, die der Auslösung von Kopfschmerzen und ihrer therapeutischen Beeinflussung durch extrakraniale Manipulationen zu Grunde liegen.

Abstract

Headaches are believed to arise from the cranial dura mater and large cerebral arteries because stimuli applied to these structures cause exclusively headache-like sensations. The contribution of extracranial structures like head and neck muscles with their trigger points has also been discussed. The convergence of afferent input to the trigemino-cervical brainstem complex is mainly regarded as an explanation for the influence of extracranial nociceptive events on the headache generation. New structural and functional examinations, particularly tracing experiments in rodent and human tissues, show clearly that collaterals of meningeal nerve fibres penetrate the skull through sutures and along blood vessels to innervate parts of the outer periosteum and deep layers of pericranial muscles. Upon noxious stimulation of these extracranial structures the excitation spreads along these afferent branches into the meninges causing neuropeptide release and increased meningeal blood flow. The concept of an extracranial innervation by meningeal afferent collaterals offers a new explanation for the role of pericranial tissues in headache generation and the beneficial effects of therapeutic manipulations on these structures.

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Danksagung

Die diesem Beitrag zu Grunde liegenden Projekte wurden durch die FAU Erlangen-Nürnberg (Emerging Fields Initiative), die Alexander von Humboldt-Stiftung (Reisestipendium für M. Dux) und die Europäische Union (FP7 Grant 602633 EUROHEADPAIN) unterstützt.

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Authors and Affiliations

  1. Institut für Physiologie & Pathophysiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 17, 91054, Erlangen, Deutschland

    K. Meßlinger, M. Schüler & R. De Col

  2. Institut für Nephrologie & Hypertensiologie, FAU Erlangen-Nürnberg, Erlangen, Deutschland

    M. Schüler

  3. Institut für Physiologie, Universität Szeged, Szeged, Ungarn

    M. Dux

  4. Institut für Anatomie, FAU Erlangen-Nürnberg, Erlangen, Deutschland

    W. L. Neuhuber

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  1. K. Meßlinger
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  5. R. De Col
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Correspondence to K. Meßlinger.

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Interessenkonflikt

K. Meßlinger, M. Schüler, M. Dux, W.L. Neuhuber und R. De Col geben an, dass kein Interessenkonflikt besteht.

Die diesem Beitrag zu Grunde liegenden tierexperimentellen Untersuchungen wurden in Übereinstimmung mit den ethischen Richtlinien der International Association for the Study of Pain und der nationalen und europäischen Gesetzgebung (Council Directive 2010/63EU) durchgeführt und von der Bezirksregierung Mittelfranken genehmigt.

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Meßlinger, K., Schüler, M., Dux, M. et al. Innervation extrakranialer Gewebe durch Kollateralen von Hirnhautafferenzen. Manuelle Medizin 54, 307–314 (2016). https://doi.org/10.1007/s00337-016-0163-2

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  • DOI: https://doi.org/10.1007/s00337-016-0163-2

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