Zusammenfassung
Auch im Alter sind chronisch-rezidivierende Kopfschmerzen ein häufiges Problem. So klagen bei den über 70-Jährigen etwa 10% der Frauen und 5% der Männer über regelmäßige Kopfschmerzen. Die Inzidenz der primären Kopfschmerzen nimmt mit dem Alter ab, die der sekundären Kopfschmerzerkrankungen eher zu. Die Symptome einer Migräne können sich im Alter ändern. So tritt die vegetative Symptomatik eher in den Hintergrund und ein nackenbetonter, nicht mehr so stark empfundener Kopfschmerz wird häufiger angegeben. Daneben können auch vermehrt isolierte Auren ohne nachfolgenden Kopfschmerz auftreten. Eine fast ausschließlich im höheren Lebensalter zu beobachtende seltene primäre Kopfschmerzerkrankung ist der primär schlafgebundene Kopfschmerz, der immer aus dem Schlaf heraus auftritt. Die im Alter relativ häufigeren sekundären Kopfschmerzformen imponieren klinisch meist als Spannungskopfschmerz. Im Alter häufigere Ursachen für sekundäre Kopfschmerzerkrankungen sind v. a. intrakranielle Raumforderungen, Augenerkrankungen und autoimmunologische Erkrankungen wie die Arteriitis temporalis. Eine Besonderheit älterer Patienten ist, dass häufig eine Multimorbidität vorliegt, die zur Einnahme mehrer verschiedener Medikamente am Tag führt, sodass auch Kopfschmerzen, ausgelöst durch eine Substanz oder deren Entzug, häufiger auftreten können. Bedingt durch diese Multimorbidität kommen Störungen der Homöostase mit begleitenden Kopfschmerzen (Schlaf-Apnoe-Syndrom, Dialysekopfschmerz, arterielle Hypertonie, Hypothyreose) ebenfalls häufiger vor. Bekannte Gesichtsneuralgien wie die Trigeminusneuralgie oder postherpetische Neuralgie nach einer Herpes-zoster-Manifestation im Gesicht zeigen eine starke Häufigkeitszunahme mit dem Lebensalter. Bei der Therapie von Kopfschmerzen im höheren Alter gilt, dass einerseits auf die Interaktion mit der bestehenden Medikation geachtet werden muss, und dass gerade bedingt durch weitere einschränkende Erkrankungen multimodale, interdisziplinäre Therapiekonzepte zur Anwendung kommen sollten.
Abstract
Chronic headache is still a frequent problem in old age, affecting about 10% of all women and 5% of all men older than 70 years. The incidence of primary headache decreases with advancing age, while that of secondary headache increases. The clinical characteristics of migraine can also change with age; for example, vegetative symptoms are less prominent, and less intense migrainous pain localized predominantly in the neck is frequently reported. Migraine aura can also be experienced more frequently in isolation, without a headache. Hypnic headache is a rare primary headache syndrome that occurs almost exclusively in the elderly. Most of the secondary headache syndromes that occur more frequently in old age present clinically as tension-type headache. Examples of rather common reasons for secondary headache syndromes in the elderly are intracranial space-occupying lesions, ophthalmological problems and autoimmune diseases such as giant cell arteritis. Elderly patients are especially likely to have a number of illnesses at any one time for which they take various medications each day, so that headaches can also quite often be caused by their medication or by withdrawal of these. As a result of such multimorbidity the homeostasis is disturbed in such patients, leading to various conditions that can entail concomitant headaches (sleep apnoea syndrome, dialysis headache, headache attributed to arterial hypertension or hypothyroidism). Familiar facial neuralgias, such as trigeminal neuralgia or postherpetic neuralgia following manifest herpes zoster affecting the face, become markedly more frequent with age. In general, in the treatment of headaches in the elderly it is essential to pay careful attention to potential interactions with the multiple drugs needed because of other diseases; in addition, the comorbidities themselves have to be taken into account, especially depression, anxiety and cognitive impairment, necessitating multimodal, interdisciplinary therapy plans.
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Danksagung
Die Arbeit wurde zum Teil durch das BMBF (chronischer Kopfschmerz, Projekt D1) unterstützt. Frau K. Ogston und Frau V. de Winter danken wir für ihre Hilfe beim Erstellen des Manuskriptes.
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Reinisch, V., Schankin, C., Felbinger, J. et al. Kopfschmerzen im Alter. Schmerz 22 (Suppl 1), 22–30 (2008). https://doi.org/10.1007/s00482-007-0609-5
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DOI: https://doi.org/10.1007/s00482-007-0609-5
Schlüsselwörter
- Verlauf primärer Kopfschmerzen im Alter
- Spezifische Kopfschmerzen im Alter
- Primär schlafgebundener Kopfschmerz
- Arteriitis temporalis
- Postherpetische Neuralgie
- Trigeminusneuralgie