Gibt es einen psychogenen Kopfschmerz?

Zusammenfassung

Es besteht eine hohe Komorbidität zwischen primären Kopfschmerzen und psychischen Erkrankungen. Eine gegenseitige Verstärkung und gemeinsame ätiologische Faktoren werden vermutet und wurden zum Teil nachgewiesen, so zum Beispiel bei Migräne und Depressionen. Eine nosologische Einteilung als sekundärer “Kopfschmerz zurückzuführen auf eine psychiatrische Störung“ verlangt eine hinreichende Evidenz für eine Auslösung oder wesentliche Verstärkung des Kopfschmerzes durch die psychische Erkrankung. Dieser Nachweis kann nur in Einzelfällen erfolgen. Größere systematische Untersuchungen fehlen. Die International Classification of Headache Disorders der International Headache Society erkennt auch in ihrer dritten Auflage (Beta-Version) nur die Somatisierungsstörung und die psychotische Störung als mögliche psychische Erkrankungen für die Auslösung sekundärer Kopfschmerzen an. Im Anhang der Klassifikation finden sich weitere psychische Erkrankungen, die möglicherweise sekundäre Kopfschmerzen auslösen können. Weitere prospektive und Längsschnittstudien sind nötig, um diese Zusammenhänge künftig besser beurteilen zu können.

Summary

There is a high rate of comorbidity of primary headache disorders and psychiatric disorders. A bidirectional fortification and common aetiological factors are assumed and partly established, e. g. in migraine and depression. A nosological classification as a secondary “headache attributed to psychiatric disorder“ postulates an acceptable evidence for a generation or a significant worsening of a headache by a psychiatric disorder. This can only be proven in particular cases. Systematic studies with a larger number of cases are missing. The International Classification of Headache Disorders of the International Headache Society up to now accepts only the somatisation disorder and the psychotic disorder as possible psychiatric diseases which might cause a secondary headache. In the appendix of the classification, further psychiatric disorders are listed which are possible candidates for causing secondary headache. Further prospective and longitudinal studies are required to reveal evidence for psychiatric diseases to induce headache disorders.

Schlüsselwörter

Sekundärer Kopfschmerz - psychogen - psychiatrische Störung - Migräne - Depression

Keywords

Secondary headache - psychogenic - psychiatric disorder - migraine - depression

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