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Entzündliche Erkrankungen des ZNS sowie immunmodulatorische Therapie und ihr Einfluss auf primäre Kopfschmerzen

Primary headaches and the influence of inflammatory diseases of the CNS and their respective immunmodulatory therapy

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Zusammenfassung

Sekundäre Kopfschmerzen im Rahmen entzündlicher systemischer oder lokaler Erkrankungen wie atypischen Pneumonien oder einer Meningitis können primären Kopfschmerzen wie Migräne oder Spannungskopfschmerzen gleichen und entstehen am ehesten durch dabei freigesetzte Entzündungsmediatoren, die sowohl direkt als auch indirekt mittels Sensibilisierung Schmerzen auslösen können. Zu diesen Entzündungsmediatoren zählen neben Prostaglandinen und Stickstoffoxid auch Zytokine wie TNF-alpha oder Interleukin-6. Aber auch bei primären Kopfschmerzen wie bei der Migräne wird angenommen, dass ähnliche entzündliche Mechanismen bei der Schmerzgenerierung eine Rolle spielen. Ein besonderes Augenmerk haben in den letzten Jahren primäre Kopfschmerzen bei entzündlichen ZNS-Erkrankungen wie der Multiplen Sklerose erfahren, da unter immunmodulatorischer Therapie gehäuft Kopfschmerzen als Nebenwirkung beobachtet wurden. Ebenso sind bei medikamentös immunsupprimierten Patienten oder Patienten mit entzündlichen Systemerkrankungen mit neurologischer Beteiligung, z. B. dem Lupus erythematodes, oder ohne neurologische Beteiligung, wie z. B. einer Helicobacter-pylori-Infektion, häufiger primäre Kopfschmerzen beschrieben worden. Dieser Artikel stellt die aktuelle Datenlage in den einzelnen Bereichen dar und erklärt mögliche Mechanismen der Schmerzentstehung und der Sensibilisierung bei primären, aber auch symptomatischen Kopfschmerzen.

Abstract

Headaches are a well known symptom in systemic or local inflammatory diseases such as pneumonia or meningitis. These headaches may mimic primary headaches and are thought to be generated by inflammatory mediators acting directly on nociceptors or indirectly – via facilitation of neurons. Apart from prostaglandin and nitric oxide also cytokines (TNF-alpha or interleukin-6) may play a role. In primary headaches such as migraine inflammatory mechanisms also have been acclaimed to contribute to pain generation. The recently observed increase of migraine attacks under immunmodulatory therapy in multiple sclerosis has focussed attention on primary headaches in states of altered immunity, for instance in autoimmune disorders like lupus erythematosus, rheumatoid arthritis, or in patients treated with immunosuppressants. This article describes the standard of knowledge and tries to shed light on possible mechanisms of pain generation in the respective conditions.

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A. Straube wird durch das BMBF (chronischer Kopfschmerz) unterstützt. M. Empl wurde durch die Doppelfeld-Stiftung gefördert.

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  1. Neurologische Klinik und Poliklinik, Klinikum Großhadern der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland

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Empl, M., Straube, A. Entzündliche Erkrankungen des ZNS sowie immunmodulatorische Therapie und ihr Einfluss auf primäre Kopfschmerzen. Schmerz 21, 415–423 (2007). https://doi.org/10.1007/s00482-006-0520-5

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