Zusammenfassung
Die chronische Migräne (CM) ist eine erst in der 2. Auflage der IHS (International Headache Society)-Klassifikation 2004 neu abgegrenzte Verlaufsform der Migräne. Dabei berichten die Patienten über Kopfschmerzen im Durchschnitt an mehr als 15 Tagen im Monat, davon an mindestens 8 Tagen über migränetypische Kopfschmerzen und es besteht kein begleitender Medikamentenübergebrauch (MOH, revidierte Klassifikation der IHS 2006). In der Praxis berichtet die Mehrzahl der Patienten über einen Medikamentengebrauch an mehr als 10 bis 15 Tagen im Monat und die einfache Unterscheidung in CM mit oder ohne begleitenden MOH ist in der Praxis häufig nicht möglich. Es finden sich bei der Mehrzahl der Patienten häufig weitere Komorbiditäten wie Depression, Angsterkrankungen und andere Schmerzerkrankungen. Eine erfolgreiche Therapie muss dieser Komplexität Rechnung tragen und besteht multimodal neben der Pharmakotherapie auch aus Verhaltenstherapie, Entspannungsverfahren und Sporttherapie. In der Akuttherapie der Kopfschmerzen ergeben sich keine Abweichungen zu der Therapie der Kopfschmerzen im Rahmen einer episodischen Migräne. Die Schmerzmitteleinnahme sollte unbedingt an weniger als 15 Tagen (für Monoanalgetika) und an weniger als 10 Tage für Triptane und Schmerzmittelmischpräparate erfolgen. In der Prophylaxe können, den nur begrenzt vorliegenden Studiendaten nach, in erster Linie Topiramat und Onabotulinumtoxin A (155–195 Units) eingesetzt werden, begrenzte Evidenz aus Studien gibt es auch für Valproinsäure und Amitriptylin. Experimentell ist eine Neuromodulation, z. B. durch die Stimulation des N. occipitalis major, möglich. Der Einsatz dieser Verfahren sollte zum jetzigen Zeitpunkt nur innerhalb von Studien erfolgen.
Summary
Chronic migraine (CM) was first defined in the second edition of the International Headache Society (IHS) classification in 2004. The definition currently used (IHS 2006) requires the patient to have headache on more than 15 days/month for longer than 3 months and a migraine headache on at least 8 of these monthly headache days and that there is no medication overuse. In daily practice the majority of the patients with CM also report medication overuse but it is difficult to determine whether the use is the cause or the consequence of CM. Most the patients also have other comorbidities, such as depression, anxiety and chronic pain at other locations. Therapy has to take this complexity into consideration and is generally multimodal with behavioral therapy, aerobic training and pharmacotherapy. The use of analgesics should be limited to fewer than 15 days per month and use of triptans to fewer than 10 days per month. Drug treatment should be started with topiramate, the drug with the best scientific evidence. If there is no benefit, onabotulinum toxin A (155–195 Units) should be used. There is also some limited evidence that valproic acid and amitriptyline might be beneficial. Neuromodulation by stimulation of the greater occipital nerve or vagal nerve is being tested in studies and is so far an experimental procedure only.
Literatur
Aurora SK, Barrodale P, Chronicle EP, Mulleners WM (2005) Cortical inhibition is reduced in chronic and episodic migraine and demonstrates a spectrum of illness. Headache 45:546–552
Aurora SK, Barrodale PM, Tipton RL, Khodavirdi A (2007) Brainstem dysfunction in chronic migraine as evidenced by neurophysiological and positron emission tomography studies. Headache 47:996–1007
Aurora SK, Dodick DW, Turkel CC et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of PREEMPT 1 trial. Cephalalgia 30:793–803
Aurora SK, Winner P, Freeman MC et al (2011) OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-Week PREEMPT clinical program. Headache 51:1358–1373
Bartsch T, Paemeleire K, Goadsby PJ (2009) Neurostimulation approaches to primary headache disorders. Curr Opin Neurol 22:262–268
Bartolini M, Silvestrini M, Taffi R et al (2005) Efficacy of topiramate and valproate in chronic migraine. Clin Neuropharmacol 28:277–279
Bigal ME, Rapoport AM, Sheftell FD et al (2004) Transformed migraine and medication overuse in a tertiary headache centre–clinical characteristics and treatment outcomes. Cephalalgia 24:483–490
Bigal ME, Rapoport AM, Tepper SJ et al (2005) The classification of chronic daily headache in adolescents–a comparison between the second edition of the international classification of headache disorders and alternative diagnostic criteria. Headache 45:582–589
Bigal ME, Lipton RB, Holland PR, Goadsby PJ (2007) Obesity, migraine, and chronic migraine: possible mechanisms of interaction. Neurology 68:1851–1861
Bigal ME, Serrano D, Buse D et al (2008) Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 48:1157–1168
Bigal ME, Lipton RB (2008) The prognosis of migraine. Curr Opin Neurol 21:301–308
Bigal M (2009) Migraine chronification–concept and risk factors. Discov Med 8:145–150
Bloudek LM, Stokes M, Buse DC et al (2012) Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS). J Headache Pain 13:361–378
Blumenfeld AM, Schim JD, Chippendale TJ (2008) Botulinum toxin type A and divalproex sodium for prophylactic treatment of episodic or chronic migraine. Headache 48:210–220
Cady RK, Schreiber CP, Porter JA et al (2011) A multi-center double-blind pilot comparison of onabotulinumtoxinA and topiramate for the prophylactic treatment of chronic migraine. Headache 51:21–32
Cecchini AP, Mea E, Tullo V et al (2009) Vagus nerve stimulation in drug-resistant daily chronic migraine with depression: preliminary data. Neurol Sci 30(Suppl 1):101–104
Cevoli S, Sancisi E, Grimaldi D et al (2009) Family history for chronic headache and drug overuse as a risk factor for headache chronification. Headache 49:412–418
Couch JR (2011) Amitriptyline in the prophylactic treatment of migraine and chronic daily headache. Headache 51:33–51
Diener HC, Bussone G, Van Oene JC et al (2007) Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 27:814–823
Diener HC, Agosti R, Allais G et al (2007) Cessation versus continuation of 6-month migraine preventive therapy with topiramate (PROMPT): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 6:1054–1062
Diener HC, Dodick DW, Aurora SK et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of PREEMPT 2 trial. Cephalalgia 30:804–814
Diener HC, Gaul C, Jensen R et al (2011) Integrated headache care. Cephalalgia 31:1039–1047
Diener HC (2012) Detoxification for medication overuse headache is not necessary. Cephalalgia 32:423–427
Dodick DW, Turkel CC, Degryse RE et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 50:921–936
Evers S, May A, Fritsche G et al (2008) Akuttherapie und Prophylaxe der Migräne. Leitlinie der Deutschen Migräne- und Kopfschmerzgesellschaft und der Deutschen Gesellschaft für Neurologie. Nervenheilkunde 27:933–949
Freitag FG, Diamond S, Diamond M, Urban G (2008) Botulinum Toxin Type A in the treatment of chronic migraine without medication overuse. Headache 48:201–209
Gaul C, Brömstrup J, Fritsche G et al (2011) Evaluating integrated headache care: a one-year follow-up observational study in patients treated at the Essen headache centre. BMC Neurol 11:124
Gaul C, Doorn C van, Webering N et al (2011) Clinical outcome of a headache specific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center. An observational study. TJHP 12:475–483
Goadsby PJ (2011) New daily persistent headache: a syndrome not a discrete disorder. Headache 51:650–653
Göbel H, Heinze A, Heinze-Kuhn K et al (2009) Entwicklung und Umsetzung der integrierten Versorgung in der Schmerztherapie. Das bundesweite Kopfschmerzbehandlungsnetz. Schmerz 23:653–670
Göbel H, Heinze A (2011) Prophylaxe der chronischen Migräne mit Botulinumtoxin Typ A. Schmerz 25:563–571
Göbel H, Heinze A (2011) Chronische Migräne und Kopfschmerz bei Medikamentenübergebrauch. Schmerz 25:493–500
Headache Classification Subcommittee of the International Headache Society (2004). The International Classificatiopn of Headache Disorders, 2. Aufl. Cephalalgia, Bd 24, S 1–160
Headache Classification Committee, Olesen J, Bousser MG et al (2006) New appendix criteria open for a broader concept of chronic migraine. Cephalalgia 26:742–746
Holroyd KA, Cottrell CK, O’Donnell FJ et al (2010) Effect of preventive (beta blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial. BMJ 341:c4871. DOI 10.1136/bmj.c4871
Jackson JL, Kuriyama A, Hayashino Y (2012) Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA 307:1736–1745
Jensen R, Zeeberg P, Dehlendorf C, Olesen J (2010) Predictors of outcome of a multidisciplinary programme in a multidisciplinary headache center. Cephalalgia 30:1214–1224
Katsarava Z, Buse DC, Manack AN, Lipton RB (2012) Defining the differences between episodic migraine and chronic migraine. Curr Pain Headache Rep 16:86–92
Krymchantowski AV (2000) Naproxen sodium decreases migraine recurrence when administered with sumatriptan. Arq Neuropsiquiatr 58(2B):428–430
Krymchantowski AV, Silva MT, Barbosa JS, Alves LA (2002) Amitriptyline versus amitriptyline combined with fluoxetine in the preventative treatment of transformed migraine: a double-blind study. Headache 42:510–514
Lantéri-Minet M, Massiou H, Nachit-Ouinekh F et al (2007) The GRIM2005 study of migraine consultation in France I. Determinants of consultation for migraine headache in France. Cephalalgia 27:1386–1397
Limmroth V, Katsarava Z, Fritsche G et al (2002) Features of medication overuse headache following overuse of different acute headache drugs. Neurology 59:1011–1014
Linde K, Allais G, Brinkhaus B et al (2009) Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev 1:CD001218
Lipton RB, Varon SF, Grosberg B et al (2011) OnabotulinumtoxinA improves quality of life and reduces impact of chronic migraine. Neurology 77:1465–1472
Magalhães E, Menezes C, Cardeal M, Melo A (2010) Botulinum toxin type A versus amitriptyline for the treatment of chronic daily migraine. Clin Neurol Neurosurg 112:463–466
Mathew NT, Frishberg BM, Gawel M et al (2005) Botulinum toxin type A (BOTOX) for the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial. Headache 45:293–307
Mathew NT, Jaffri SF (2009) A double-blind comparison of onabotulinumtoxina (BOTOX) and topiramate (TOPAMAX) for the prophylactic treatment of chronic migraine: a pilot study. Headache 49:1466–1478
Mo’tamedi H, Rezaiemaram P, Tavallaie A (2012) The effectiveness of a group-based acceptance and commitment additive therapy on rehabilitation of female outpatients with chronic headache: preliminary findings reducing 3 dimensions of headache impact. Headache DOI 10.1111/j.1526-4610.2012.02192.x. [Epub ahead of print]
Munakata J, Hazard E, Serrano D et al (2009) Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache 49:498–508
Natoli JL, Manack A, Dean B et al (2010) Global prevalence of chronic migraine: a systematic review. Cephalalgia 30:599–609
Ondo WG, Vuong KD, Derman HS (2004) Botulinum toxin A for chronic daily headache: a randomized, placebo-controlled, parallel design study. Cephalalgia 24:60–65
Ozturk V, Cakmur R, Donmez B et al (2002) Comparison of cortical excitability in chronic migraine (transformed migraine) and migraine without aura. A transcranial magnetic stimulation study. J Neurol 249:1268–1271
Rueda-Sánchez M, Díaz-Martínez LA (2008) Prevalence and associated factors for episodic and chronic daily headache in the Colombian population. Cephalalgia 28:216–225
Saper JR, Dodick DW, Silberstein SD et al (2010) Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalalgia 3:271–285
Scher AI, Stewart WF, Ricci JA, Lipton RB (2003) Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 106:81–89
Serra G, Marchioretto F (2012) Occipital nerve stimulation for chronic migraine: a randomized trial. Pain Physician 15:245–253
Silberstein SD, Lipton RB, Sliwinski M (1996) Classification of daily and near-daily headaches: field trial of revised IHS criteria. Neurology 47:871–875
Silberstein SD, Stark SR, Lucas SM et al (2005) Botulinum toxin type A for the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc 80:1126–1137
Silberstein SD, Lipton RB, Dodick DW et al (2007) Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind, placebo-controlled trial. Headache 47:170–180
Silberstein SD, Dodick DW, Lindblad AS et al (2012) Randomized, placebo-controlled trial of propranolol added to topiramate in chronic migraine. Neurology 78:976–984
Spira PJ, Beran RG (2003) Australian gabapentin chronic daily headache group. Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study. Neurology 61:1753–1759
Straube A, May A, Kropp P et al (2008) Therapie primärer chronischer Kopfschmerzen. Chronische Migräne, chronischer Kopfschmerz vom Spannungstyp und andere chronische tägliche Kopfschmerzen. Schmerz 22:531–543
Straube A, Pfaffenrath V, Ladwig KH et al (2010) Prevalence of chronic migraine and medication overuse headache in Germany–the German DMKG headache study. Cephalalgia 30:207–213
Straube A (2010) Botulinumtoxin bei Kopfschmerzen: Ende eines langen Weges? Akt Neurol 37:327–332
Tietjen GE, Brandes JL, Peterlin BL et al (2010) Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache 50:32–41
Tietjen GE, Brandes JL, Peterlin BL et al (2010) Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache 50:20–31
Winter AC, Hoffmann W, Meisinger C et al (2011) Association between lifestyle factors and headache. J Headache Pain 12:147–155
Yang CP, Chang MH, Liu PE et al (2011) Acupuncture vs. Topiramate in chronic migraine prophylaxis. Cephalalgia 31:1510–1521
Yurekli VA, Akhan G, Kutluhan S et al (2008) The effect of sodium valproate on chronic daily headache and its subgroups. J Headache Pain 9:37–41
Zeeberg P, Olesen J, Jensen R (2006) Probable medication-overuse headache: the effect of a 2-month drug-free period. Neurology 66:1894–1898
Interessenkonflikt
Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: siehe DGV-Homepage (DGV-LL)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Straube, A., Gaul, C., Förderreuther, S. et al. Therapie und Versorgung bei chronischer Migräne. Nervenarzt 83, 1600–1608 (2012). https://doi.org/10.1007/s00115-012-3680-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00115-012-3680-9