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Nervenheilkunde 2008; 27(12): 1127-1137
DOI: 10.1055/s-0038-1627355
Originaler Artikel
Schattauer GmbH

Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter

Revidierte Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG) und der Gesellschaft für Neuropädiatrie (GNP)Treatment of idiopathic headache in childhoodRevised recommendations of the German Migraine and Headache Society and of the Society for Neuropediatrics
S. Evers
1   Universitätsklinikum Münster
,
P. Kropp
2   Medizinische Fakultät der Universität Rostock
,
R. Pothmann
2   Medizinische Fakultät der Universität Rostock
,
F. Heinen
3   Dr. von Haunersches Kinderspital, München
,
F. Ebinger
4   Universitätsklinikum Heidelberg
› Author Affiliations
Further Information

Publication History

Eingegangen am: 11 September 2008

angenommen am: 20 October 2008

Publication Date:
20 January 2018 (online)

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Zusammenfassung

Nach den Richtlinien der Evidence Based Medicine sind die spezifischen kontrollierten Studien für die Behandlung von idiopathischen Kopfschmerzen im Kindes- und Jugendalter analysiert und in Therapieempfehlungen zusammengefasst worden. Mit der höchsten Evidenz wird für die Behandlung akuter Migräneattacken oder von Kopfschmerzen vom Spannungstyp Ibuprofen empfohlen. Als Mittel der zweiten Wahl wird für alle Altersstufen Paracetamol empfohlen, ab dem 12. Lebensjahr ist für Migräneattacken auch Sumatriptan Nasenspray Mittel der zweiten Wahl (im Einzelfall kann es auch bei jüngeren Kindern eingesetzt werden). Bei Versagen der Akutmedikamente der ersten und zweiten Wahl werden als Ausweichsubstanzen der dritten Wahl Zolmitriptan als Schmelztablette, Zolmitriptan als Nasenspray, Rizatriptan, Almotriptan und Dihydroergotamin empfohlen. Für die medikamentöse Prophylaxe der Migräne werden Magnesium, Betablocker (Propranolol oder Metoprolol) und Flunarizin empfohlen. Flunarizin ist auch prophylaktisches Mittel der ersten Wahl bei migräneähnlichen Syndromen. Für andere Kopfschmerzarten liegen keine kontrollierten Studien für das Kindesalter vor. In der nicht medikamentösen Prophylaxe von Kopfschmerzen im Kindesalter werden mit höchster Evidenz Entspannungsverfahren (progressive Muskelrelaxation), Biofeedbackverfahren und kindgerechte kognitiv-verhaltensorientierte Therapieprogramme empfohlen.

Summary

According to the principles of evidence-based medicine, the controlled studies on the treatment of idiopathic headache in childhood have been analysed and compiled to treatment recommendations. For the acute treatment of migraine attacks or tension-type headache, ibuprofen is recommended with highest evidence. Drugs of second choice are acetaminophen for all ages and, for migraine attacks only, intranasal sumatriptan for the age of twelve and older, in single cases also in the age below twelve. If the acute drugs of first or second choice are not efficacious, alternative drugs of third choice are zolmitriptan as melting tablet, intranasal zolmitriptan, rizatriptan, almotriptan, and dihydroergotamine. For the prophylaxis of migraine, magnesium, betablockers (propranolol and metoprolol), and flunarizine are recommended. Flunarizine is the drug of first choice in the treatment of migraine-related disorders. No controlled studies are available for the treatment of further headache types. First line methods for the nondrug treatment of headache in childhood are relaxation therapies, biofeedback, and specific cognitive-behavioral therapeutic schedules.

Schlüsselwörter

Kindes- und Jugendalter - Migräne - Kopfschmerz vom Spannungstyp - Therapieempfehlungen

Keywords

Childhood - adolescence - migraine - tension-type headache - treatment recommendations
 

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