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Klin Padiatr 2019; 231(01): 14-20
DOI: 10.1055/a-0710-5014
Übersicht / Review
© Georg Thieme Verlag KG Stuttgart · New York

Chronische Kopfschmerzen bei Kindern und Jugendlichen

Chronic Headache in Children and Adolescents
Markus Blankenburg
1   Zentrum für Kinder- und Jugendmedizin Olgahospital, Pädiatrische Neurologie, Psychosomatik und Schmerztherapie, Kinderschmerzzentrum Baden-Württemberg, Stuttgart
2   Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Kinderschmerztherapie und pädiatrische Palliativmedizin
,
Michael Schroth
1   Zentrum für Kinder- und Jugendmedizin Olgahospital, Pädiatrische Neurologie, Psychosomatik und Schmerztherapie, Kinderschmerzzentrum Baden-Württemberg, Stuttgart
,
Sarah Braun
1   Zentrum für Kinder- und Jugendmedizin Olgahospital, Pädiatrische Neurologie, Psychosomatik und Schmerztherapie, Kinderschmerzzentrum Baden-Württemberg, Stuttgart
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Publikationsverlauf

Publikationsdatum:
15. Oktober 2018 (online)

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Zusammenfassung

Primäre Kopfschmerzerkrankungen wie Spannungskopfschmerzen und Migräne beginnen in der Kindheit und werden mit der Einschulung und Pubertät häufiger. Bei Spannungskopf-schmerzen spielt die zentrale Schmerzsensibilisierung und Aktivierung zentraler nozizeptiver Neurone eine wichtige Rolle. Die Migräne ist eine primäre Erkrankung des Gehirns mit Auffälligkeiten schmerzmodulierender Systeme und der kortikalen Reizverarbeitung. Bei beiden Kopfschmerzformen spielen bio-psycho-soziale Faktoren eine entscheidende Rolle. Sekundäre Kopfschmerzen durch eine entzündliche oder strukturelle hirnorganische Ursache sind selten. Die Diagnose erfolgt anhand der Anamnese und der körperlichen Untersuchung sowie apparativer Untersuchungen bei Auffälligkeiten. Bei Spannungskopfschmerzen steht die multimodale Schmerztherapie im Vordergrund, bei Migräne die medikamentöse Therapie der Attacken und bei sekundären Kopfschmerzen die Behandlung der Grunderkrankung. Behandlungsziele sind die Minderung der Schmerzwahrnehmung, Förderung von Kontroll- und Selbstwirksamkeitserfahrungen, die Steigerung der körperlichen Leistungsfähigkeit sowie die Wiederaufnahme normaler Alltagsstrukturen und sozialer Kontakte als Voraussetzung für eine zunehmende Schmerzminderung.

Abstract

Primary headache disorders such as migraine and tension-type headache begin as early as childhood or adolescence. Prevalence increases during primary school and adolescence. In tension-type headache, central pain sensitization and activation of central nociceptive neurons plays an important role. Migraine is a primary brain disorder with abnormalities in pain modulating systems and cortical stimulus processing. Bio-psycho-social factors play a decisive role in both types of headache. Secondary headaches due to an inflammatory or a structural brain alteration are rare. Diagnosis is based on clinical criteria. Typical recurrent headaches are diagnosed by patient’s history and physical examination. In case of abnormalities, further diagnostic is needed. Treatment of tension-type headache is focused on multimodal pain therapy, treatment of migraine is focused on medication of attacks and secondary headaches need treatment of the underlying disease. Treatment goals are the reduction of pain perception, promotion of control and self-efficacy experiences, the increase of physical performance as well as the resumption of normal everyday structures and social contacts as a prerequisite for an increasing pain reduction.

Schlüsselwörter

Migräne - Spannungskopfschmerzen - chronische Schmerzstörung - multimodale Therapie - Kinder und Jugendliche

Key words

Migraine - tension-type headache - chronic pain disorder - multimodal treatment approach - children and adolescents
 

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