Kopfschmerzen in der Notaufnahme – Schritt für Schritt

Kopfschmerzen in der Notaufnahme sind häufig. Ihre Einordnung bereitet besondere Schwierigkeiten, wenn ein normaler neurologischer Befund vorliegt. Differentialdiagnostisch kommen primäre Kopfschmerzerkrankungen und viele symptomatische Syndrome in Betracht. Anhand von Anamnese und Befund sollte eine Verdachtsdiagnose erstellt und in Abhängigkeit von dieser ggf. gezielte Zusatzdiagnostik mit einer klaren Fragestellung formuliert werden. Zweifellos kommt der bildgebenden Diagnostik ein hoher Stellenwert zu, doch können auch schwerwiegende Differentialdiagnosen der Routinebildgebung entgehen. Die vorliegende Arbeit stellt wichtige Differentialdiagnosen in Abhängigkeit von ihrem klinischen Syndrom dar und beschreibt die erforderlichen diagnostischen Schritte zur Diagnosesicherung.

Fazit

Kopfschmerzen führen häufig zur Vorstellung in einer Notaufnahme. Primäre Aufgabe ist die Differenzierung zwischen primären (Migräne, Clusterkopfschmerz) und sekundären Kopfschmerzen (z. B. Subarachnoidalblutung, Sinus-Venen-Thrombose). Dafür sollte man gemäß der SNOOP-Liste systemische, sowie neurologische Zeichen, den Beginn der Kopfschmerzen, das Alter des Patienten und die Vorgeschichte berücksichtigen. Sekundären Ursachen sind bei Kindern und älteren Menschen häufiger. Allein durch Routinebildgebung können symptomatische Ursachen nicht ausgeschlossen werden.

Publikationsverlauf

Artikel online veröffentlicht:
17. Februar 2020

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