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Der gordische Knoten: medikamenteninduzierte Kopfschmerzen

Gordian knot: medication overuse headache

Der Schmerz volume 18, pages 421–424 (2004)Cite this article

Zusammenfassung

Der Missbrauch jeglicher Schmerz- und Kopfschmerzmittel kann bei Kopfschmerzpatienten zur Entwicklung eines medikamenteninduzierten Kopfschmerzes (MIKS) führen. Typischerweise entwickeln Patienten mit Analgetikamissbrauch einen MIKS vom Spannungstyp, Patienten mit Triptanmissbrauch dagegen einen täglichen migräneartigen Dauerkopfschmerz oder eine deutliche Zunahme der Migräneattackenfrequenz. Die durchschnittliche kritische Einnahmedauer zur Ausbildung eines MIKS ist am kürzesten für die Triptane (1,7 Jahre), länger für Ergotamine (2,7 Jahre) und am längsten für Analgetika (4,8 Jahre). Die Therapie des MIKS besteht aus dem Entzug der missbrauchten Substanzen und einer sowohl medikamentösen als auch psychologischen Kopfschmerz- und Rückfallprophylaxe. Die Rückfallrate nach zunächst erfolgreichem Entzug beträgt ca. 30%. Der Kopfschmerztyp und die missbrauchte Medikamentenklasse haben sich als Prädiktoren für einen Rückfall erwiesen: Die ungünstigste Prognose haben Patienten mit Spannungskopfschmerz und Missbrauch von Kombinationsanalgetika oder Opioiden.

Abstract

Overuse of any kind of headache drugs may lead to the development of the medication overuse headache (MOH). Clinical features of MOH depend on the substance class that has been overused. Overuse of analgesics leads to a chronic tension-type like headache, the overuse of triptans to daily migraine-like headache or to the increase of migraine frequency. The delay between the drug overuse and onset of daily headache is shortest for triptans (1.7 years), longer for ergots (2.7 years) and longest for analgesics (4.8 years). Treatment includes withdrawal followed by structured acute therapy and initiation of specific prophylactic treatment for the underlying primary headache. The relapse rate after a successful withdrawal is about 30%. Predictors for relapse are tension-type headache and the overuse of analgesics in combination with codeine, caffeine or opioids.

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Affiliations

  1. Neurologische Klinik, Universitätsklinikum Essen

    Z. Katsarava & G. Fritsche

  2. Neurologische Klinik, Universitätsklinikum, Hufelandstr. 55, 45122 , Essen

    Z. Katsarava

Authors
  1. Z. Katsarava
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  2. G. Fritsche
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Correspondence to Z. Katsarava.

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Katsarava, Z., Fritsche, G. Der gordische Knoten: medikamenteninduzierte Kopfschmerzen. Schmerz 18, 421–424 (2004). https://doi.org/10.1007/s00482-004-0355-x

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  • DOI: https://doi.org/10.1007/s00482-004-0355-x

Schlüsselwörter

  • Medikamentenmissbrauch
  • Medikamenteninduzierter Kopfschmerz
  • Migräne
  • Spannungskopfschmerz
  • Rückfallrate

Keywords

  • Medication overuse
  • Medication overuse headache
  • Migraine
  • Tension type headache
  • Relapse rate