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PET und Dopplersonographie bei Kopfschmerzen

PET and Doppler sonography in headaches

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Zusammenfassung

Bei der Migräne handelt es sich um eine komplexe Funktionstörung neuronaler und vaskulärer Elemente des ZNS. Die ursprüngliche Theorie einer primär vaskulären Erkrankung im Sinne intra- und extrakranieller arterieller Kaliberschwankungen ist überholt. Aufgrund umfangreicher dopplersonographischer Untersuchungen und Blutflußuntersuchungen mit Hilfe bildgebender Verfahren (SPECT und PET) muß man von einer zentral gesteuerten Imbalance trigeminal nozizeptiver, endogen antinozizeptiver und den vaskulären Tonus regelnder Hirnstammkerne ausgehen. Wenn arterielle Kaliberschwankungen während der akuten Migräneattacke oder der medikamentösen Therapie mit z. B. Sumatriptan oder Ergotaminen auftreten, so sind dies Lokalphänomene ohne Einfluß auf den kortikalen Butfluß. Der eigentliche Kopfschmerz entsteht in der Peripherie im Bereich der großen zerebralen Blutleiter, am ehesten im Gefolge einer aseptischen perivaskulären Entzündung dieser Gefäße.

Abstract

Whether the primary mechanisms of migraine are vascular or neurogenic is, as yet unresolved. Early studies using Doppler sonography prompted heterogeneous results, mainly due to methodological differences. However, blood flow measurements using single photon emission tomography (SPECT) or positron emission tomography (PET) have not revealed any differences in cerebral blood flow in migraine without aura. Moreover, specific migraine compounds do not alter cortical blood flow. During attacks, increased blood flow is found in the cerebral hemispheres in cingulate, auditory and visual association cortices and the brain stem. Alltogether, these findings suggest that the pathogenesis of migraine is related to an imbalance in activity between brain stem nuclei regulating antinociception and vascular control, rather than in primary vessel diameter changes.

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  1. Neurologische Universitätsklinik, Hufelandstrasse 55, D-45 122, Essen

    A. May & C. Weiller

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  1. A. May
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May, A., Weiller, C. PET und Dopplersonographie bei Kopfschmerzen. Schmerz 10, 140–145 (1996). https://doi.org/10.1007/s004820050034

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  • DOI: https://doi.org/10.1007/s004820050034

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