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Progressive Muskelrelaxation nach Jacobson bei der Migräneprophylaxe

Klinische Effektivität und Wirkmechanismen

Progressive muscle relaxation according to Jacobson for migraine prophylaxis

Clinical effectiveness and mode of action

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Zusammenfassung

Seit Anfang der 1970er-Jahre wird die progressive Muskelrelaxation (PMR) nach Jacobson in der Migräneprophylaxe eingesetzt. Hintergrund ist die Annahme, dass Migränepatienten eine erhöhte autonome Aktivierung aufweisen, der man mit systematischer Entspannung entgegensteuern kann. Entspannungsverfahren reduzieren neben dem Aktivierungsniveau auch die zentrale Schmerzverarbeitung, außerdem bewirken entspannende Strategien eine Aktivierung in schmerzhemmenden Strukturen im periaquäduktalen Grau. Metaanalysen zeigen, dass die PMR ebenso wirksam ist wie medikamentöse Verfahren. Ein guter Effekt stellt sich nur dann ein, wenn regelmäßig täglich mindestens 5–25 min geübt wird und ein Transfer der Übungen in den Alltag erfolgt. Diese Übersicht fasst die empirischen Belege für die Wirksamkeit von PMR bei Migräne kritisch zusammen. Es wird ein Mangel insbesondere an aktuellen Studien zur Thematik festgestellt. In einer eigenen Studie mit 50 Migränepatienten und 46 gesunden Kontrollen konnte neben der klinischen Wirksamkeit auch eine Änderung der kortikalen Aufmerksamkeitszuwendung bei der Messung der kontingenten negativen Variation („contingent negative variation“ [CNV]) nachgewiesen werden. Die zuvor erhöhte CNV-Amplitude normalisierte sich bei regelmäßiger Anwendung der PMR bei Migränepatienten. Mit der Übersicht über PMR-Studien zur Migräneprophylaxe und mit der eigenen Studie kann gezeigt werden, dass PMR ein effektives nichtmedikamentöses Verfahren zur Migräneprophylaxe ist und dass neben den klinischen Effekten auch nachweisbare Änderungen der kortikalen Reizverarbeitung im Sinne einer Normalisierung bewirkt werden können.

Abstract

Progressive muscle relaxation (PMR) after Jacobson has been used for migraine prophylaxis since the early 1970s. Migraine patients are assumed to have an enhanced autonomic arousal which can be counterbalanced by systematic relaxation. Relaxation techniques are thought to reduce the activation level, to alter cortical pain processing and to enhance activation in pain-reducing cortical structures in the periaqueductal grey matter. Meta-analyses could show PMR to be just as efficacious as pharmacological treatment options. A beneficial effect can only arise if regular daily exercises of 5–25 min are performed and the exercises are transferred into the daily routine. This review critically summarizes the empirical findings concerning the effects of PMR on migraine. A lack of recent research on this topic was determined. In a study by this group 50 migraine patients and 46 healthy controls were examined. It could be shown that in addition to the clinical efficacy on migraine frequency, changes in cortical information processing, measured by means of the evoked potential contingent negative variation (CNV) could also be determined. The initially increased CNV amplitude became normalized after regular PMR training in migraine patients. With the review of PMR studies on migraine prophylaxis and the results of our own study it could be shown that PMR is an efficacious non-pharmacological treatment option for migraine prophylaxis. In addition to its clinical effects, alterations in cortical stimulation processing in terms of a normalization of the CNV could be documented.

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  1. Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Gehlsheimer Straße 20, 18147, Rostock, Deutschland

    B. Meyer, A. Keller, B. Müller, H.-G. Wöhlbier & P. Kropp

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Correspondence to B. Meyer.

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Interessenkonflikt

B. Meyer erhielt eine Forschungsförderung der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG) für die Durchführung der Studie „PMR bei Migräne – Einfluss auf den Krankheitsverlauf“. A. Keller, B. Müller, H.-G. Wöhlbier und P. Kropp geben an, dass kein Interessenkonflikt besteht.

Alle Untersuchungen wurden mit Zustimmung der Ethikkommission der Universitätsmedizin Rostock, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 durchgeführt. Von allen beteiligten Personen liegt eine Einverständniserklärung vor.

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Meyer, B., Keller, A., Müller, B. et al. Progressive Muskelrelaxation nach Jacobson bei der Migräneprophylaxe. Schmerz 32, 250–258 (2018). https://doi.org/10.1007/s00482-018-0305-7

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