Physiotherapie bei Kopfschmerzen vom Spannungstyp und Migräne

ZUSAMMENFASSUNG

Migräne und Kopfschmerzen gehen oft mit Nackenschmerzen einher. Ob die Nackenschmerzen Symptom, Auslöser oder aufrechterhaltender Faktor der Kopfschmerzen sind, muss im Einzelfall durch eine Anamnese und eine evidenzbasierte Untersuchung festgestellt werden. Grundlage für diese Wechselwirkungen sind Konvergenzen des N. trigeminus mit afferenten Fasern der Spinalnerven C1–3 im trigeminalen Kerngebiet. Es existieren mittlerweile mehrere Übersichtsarbeiten, in denen muskuloskelettale Auffälligkeiten sowie die Wirksamkeit physiotherapeutischer Techniken analysiert werden. Demnach werden 5 physiotherapeutische Tests empfohlen, die bei Patienten mit Migräne häufiger positiv sind als bei Kontrollprobanden. In mehreren Reviews wird auf die Notwendigkeit einer Kombination von Techniken hingewiesen (Hands-off und Hands-on). Durch diese multimodalen Ansätze lassen sich bei einem Teil der Patienten Kopfschmerzen lindern und Migräneattacken reduzieren. Weitere methodisch solide Studien sind notwendig, um die Ergebnisse zu stützen.

ABSTRACT

Migraine and headache are often associated with neck pain. Whether neck pain is a symptom, trigger, or maintaining factor of headache must be determined on a case-by-case basis and by anamnesis and evidence-based examination. The basis for these interactions is convergences of the trigeminal nerve with afferent fibers of spinal nerves C1–3 in the trigeminal nucleus area. Several reviews now exist in which musculoskeletal abnormalities and the efficacy of physiotherapeutic techniques have been analyzed. According to these, five physiotherapeutic tests are recommended, which are more frequently positive in patients with migraine than in control subjects. Several reviews point out the need for a combination of techniques (hands-off and hands-on). These multimodal approaches can relieve headaches in some patients and reduce migraine attacks. Further studies with low risk of bias are needed to support the results.

Schlüsselwörter

Physiotherapie - Kopfschmerzen vom Spannungstyp - Migräne - Evidenz - Edukation

Key words

Physiotherapy - tension-type headache - migraine - evidence - education

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