Trigemino-autonome Kopfschmerzen – neue Aspekte und Konzepte

Zusammenfassung

Cluster-Kopfschmerz, paroxysmale Hemikranie und SUNCT-Syndrom sind als „Trigemino-autonome Kopfschmerzen“ (TAKs) klassifiziert. Sie gehören zur Gruppe der primären Kopfschmerzsyndrome. Deren gemeinsames Kennzeichen sind relativ kurz andauernde Attacken streng einseitiger Kopfschmerzen mit ipsilateral-autonomen Begleitsymptomen. Diese drei Kopfschmerz-Syndrome werden maßgeblich durch die Länge der Attacken charakterisiert und unterschieden. Durch den Einsatz moderner bildgebender Verfahren konnte ein besseres Verständnis der Pathophysiologie erlangt werden, sodass der Hypothalamus als ein gemeinsames strukturelles und funktionelles Kennzeichen der TAKs in den Fokus rückte. Therapeutisch gliedern sich konservativ-medikamentöse Regime in die Attackenkupierung sowie die prophylaktische Medikation. Nach Ausschöpfen aller konservativen Therapieoptionen sind invasive Verfahren gerechtfertigt, wobei zukünftig eher neurostimulative Verfahren als neurodestruktive Techniken zur Anwendung kommen.

Abstract

Cluster headache, paroxysmal hemicrania and SUNCT syndrome are a group of primary headaches classified as „trigeminal autonomic cephalgias“ (TACs) and characterised by relatively short attacks of unilateral head pain associated with ipsilateral craniofacial autonomic manifestations. Duration of attacks is the main feature to distinguish between the three forms of TACs. Modern functional neuroimaging indicates that the hypothalamus may play a crucial role in the pathophysiology of these headaches. Therapeutic regimes consist of acute treatment as well as application of prophylactic medication. After unsuccessful application of conservative treatment options, invasive neuromodulative procedures are finally justified. These treatments should be rather of neurostimulative than of neurodestructive intentions.

Schlüsselwörter

trigemino-autonome Kopfschmerzen - Cluster-Kopfschmerz - paroxysmale Hemikranie - SUNCT

Key words

trigeminal autonomic cephalalgias - cluster headache - paroxysmal hemicrania - SUNCT

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