Leitlinie zur Diagnostik, Therapie und Prophylaxe von Cluster-Kopfschmerz, anderen trigeminoautonomen Kopfschmerzen, schlafgebundenem Kopfschmerz und idiopathisch stechenden Kopfschmerzen

A. May; S. Evers; G. Brössner; T. Jürgens; A. R. Gantenbein; V. Malzacher; A. Straube

doi:10.1055/s-0037-1616368

Nervenheilkunde, Inhaltsverzeichnis

Nervenheilkunde 2016; 35(03): 137-151
DOI: 10.1055/s-0037-1616368

Leitlinie

Schattauer GmbH

Leitlinie zur Diagnostik, Therapie und Prophylaxe von Cluster-Kopfschmerz, anderen trigeminoautonomen Kopfschmerzen, schlafgebundenem Kopfschmerz und idiopathisch stechenden Kopfschmerzen

Überarbeitete Therapieempfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft in Zusammenarbeit mit der DGN, ÖKSG, SKGGuideline for diagnostic, therapy and prophylaxis of cluster headache, as trigemino-autonomic cephalgias, sleep associated headache and idiopathic headacheRevised therapy recommendations of the German Migraine and Headache Society in cooperation Working with the DGN, ÖKSG, SKG

A. May

¹Institut für Systemische Neurowissenschaften, Uniklinik Hamburg Eppendorf

,

S. Evers

²Klinik für Neurologie, Krankenhaus Lindenbrunn, Coppenbrügge und Universitätsklinikum Münster

,

G. Brössner

³Universitätsklinik für Neurologie, Innsbruck

,

T. Jürgens

⁴Klinik für Neurologie, Universitätsklinik Rostock

,

A. R. Gantenbein

⁵Neurorehabilitation, RehaClinic, Bad Zurzach, Schweiz

,

V. Malzacher

⁶Neurologische Praxis, Reutlingen

,

A. Straube

⁷Klinik und Poliklinik für Neurologie, Universität München Großhadern, München

› Institutsangaben

Abstract

Zusammenfassung

Nach der 2013 überarbeiteten IHS-Klassifikation werden der episodische und chronische Cluster-Kopfschmerz, die episodisch und chronisch paroxysmale Hemikranie und SUNCT-Syndrom (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing) und das SUNA-Syndrom (short-lasting unilateral neuralgiform headache with autonomic symptoms) sowie die Hemicrania continua unter dem Begriff trigemino-autonome Kopfschmerzen (TAK) zusammengefasst. Sie unterscheiden sich in Dauer, Frequenz und Rhythmik der Schmerzattacken. Autonome Begleitsymptome wie ipsilaterale Lakrimation, konjunktivale Injektion, Rhinorrhoe, nasale Kongestion, Gesichtsschwitzen, Völlegefühl im Ohr und Lidschwellung treten mehr oder weniger stark ausgeprägt auf. Ein wesentliches weiteres Unterscheidungsmerkmal liegt in dem unterschiedlichen Ansprechen auf Indometacin: Der Cluster-Kopfschmerz und das SUNCT- und SUNA-Syndrom sprechen nicht auf Indometacin an, bei den anderen TAK ist Indometacin per definitionem effektiv. Grundsätzlich unterteilt sich die Therapie der TAK in eine Akuttherapie und eine medikamentöse Prophylaxe. Aufgrund der relativen Kürze der Attacken ist bei der paroxysmalen Hemicranie und beim SUNCT/SUNA-Syndrom keine Akuttherapie möglich, beim Cluster-Kopfschmerz sind orale Substanzen in der Regel nicht ausreichend rasch wirksam. Das größte Augenmerk der Therapie liegt daher stets auf der Prophylaxe. Die Therapie der TAK erfordert eine individuell auf den Patienten zugeschnittene Kombination der verschiedenen Therapieoptionen. Obwohl ausreichend gute, vergleichende Studien rar sind, kann in der Praxis in der Mehrzahl der Fälle eine positive Beeinflussung der Schmerzattacken erreicht werden. Nur in seltenen Fällen ist eine invasive Therapie nötig. Die Therapieempfehlungen stützen sich, soweit möglich, auf Kriterien der evidenzbasierten Medizin (EBM).

Summary

Following the 2013 IHS-classification, cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) and conjunctival injection and tearing (SUNCT) are included into the classification as trigemino-autonomic cephalgias (TAC). The similarities of these syndromes suggest a considerable shared pathophysiology. These syndromes have in common that they involve activation of trigeminovascular nociceptive pathways with reflex cranial autonomic activation. Clinically, this physiology predicts pain with some combination of ipsilateral lacrimation, conjunctival injection, nasal congestion, facial sweating or eyelid oedema. Broadly the management of TAC comprises acute and prophylactic treatment. Some types of trigemino-autonomic headaches, such as paroxysmal hemicrania and hemicrania continua have, unlike cluster headaches, a very robust response to indometacin, leading to a consideration of indometacin-sensitive headaches. This review covers the clinical picture and therapeutic options. Although studies following the criteria of evidence based medicine (EBM) are rare, most patients can be treated sufficiently. In medically intractable patients promising invasive treatments have emerged.

Schlüsselwörter

Trigemino-autonome Kopfschmerzen - Cluster-Kopfschmerz - schlafgebundener Kopfschmerz - Therapie - EBM-Kriterien

Keywords

Trigemino-autonomic cephalgias - cluster headache - hypnic headache - treatment - EBM-criteria

Volltext

Referenzen

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