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Nervenheilkunde 2018; 37(01): 60-67
DOI: 10.1055/s-0038-1631175
Kopfschmerz
Schattauer GmbH

Kopfschmerz bei Medikamentenübergebrauch

Primärer oder sekundärer Kopfschmerz?Medication overuse headachePrimary or secondary headache?
Z. Katsarava
1   Klinik Für Neurologie, Stiftung Evangelisches Krankenhaus Unna
,
S. Nägel
2   Neurologische Klinik und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen
› Author Affiliations
Further Information

Publication History

eingegangen am: 01 December 2017

angenommen am: 20 December 2017

Publication Date:
09 February 2018 (online)

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Zusammenfassung

Es ist ein durch die Internationale Kopfschmerzgesellschaft akzeptierter Konsens,dass die häufige Einnahme von Akutmedikation zur Zunahme oder Chronifizierung von episodischen Kopfschmerzen führen kann.Dieser Kopfschmerz wird als Medikamentenübergebrauchskopfschmerz(MÜKS) bezeichnet.Definiert ist der MÜKS als ein Kopfschmerz,der an mindestens 15 Tagen pro Monat bei Patienten, die seit über 3 Monaten Akuttherapeutika im Übermaß einnehmen,auftritt. Die kritische Einnahmegrenze liegt für Triptane, Opioide und Kombinationsanalgetikabei 10 Tagen, für einfache Analgetikabei 15 Tagen pro Monat. Das Konzept fußt auf der Annahme, dass Menschen mit Migräne oder einem Kopfschmerz vom Spannungstyp ein besonders vulnerables trigeminalesSchmerzsystem haben, welches auf Schmerzmittelübergebrauchmit Sensitisierung der Schmerzverarbeitung und Chronifizierung des Kopfschmerzes reagiert. Der MÜKS wirddeswegen als sekundärer Kopfschmerz betrachtet.Das Mittel der Wahl zur Behandlungist nach aktueller Lehrmeinung eine Entzugsbehandlung.Diesem Konzept wird aber widersprochen.Die Gegner argumentieren,dass die häufige Schmerzmitteleinnahme lediglichbei einem Teil der Kopfschmerzpatientenzur Chronifizierung führt und man sich beidiesen nicht sicher sein kann, dass die Zunahme der Kopfschmerzfrequenz tatsächlich dieFolge des Schmerzmittelgebrauches ist, sondern,dass der übermäßige Schmerzmittelgebrauchdie Folge der häufigeren/chronifizierten Kopfschmerzen ist. Weiter wird argumentiert,die Verläufe würden sich nicht infolge derEntzugsbehandlung, sondern als Konsequenz einer multimodalen Therapie inklusive medikamentöser Prophylaxe und psychologischerund edukativer Betreuung bessern. Deswegensei der MÜKS keine eigene Entität. Durch dieDiagnose eines MÜKS stigmatisiere man dieBetroffenen, enthalte ihnen die nötigenSchmerzmedikamente vor und lasse sie unnötigleiden. In dieser Übersichtsarbeit beleuchtendie Autoren den aktuellen Stand der Literaturund stellen die Argumente für und gegenden MÜKS dar.

Summary

It is consented by the International Headache Society that the frequent intake of acute medicationcan induce an increase or chronification of preexisting episodic primary headache disorders. This headache type is called medication overuse headache (MOH). MOH is defined as a headache on more than 15 daysper month in patients who take too many acute medications for at least 3 months. The critical border for his intake is 10 days per month for triptans, opioids and combined analgesics and 15 days per month for simple analgesics. This concept is based on the assumptionthat patients with migraine or tension-type headache have a specifically vulnerable trigeminal pain system which responds to the overuse of analgesics with asensitisation of the pain processing and withchronification of headache. MOH is therefore regarded as a secondary headache. Treatment of choice is withdrawal therapy according to current guidelines. This is, however, often debated. Often, frequent intake of analgesics induces chronification only in a part of headache patients, and even in these patientsone cannot be sure that the increase of headache frequency really is the consequenceof the frequent analgesic intake; thefrequent intake of analgesics can more over be the consequence of frequent headache. Furthermore, the so-called withdrawal therapyis not the cause of improvement in theseheadache patients, but the multimodal therapy including medication prophylaxis and psychological and educational advice. Therefore, MOH is not a separate entity. Due to thediagnosis of MOH, patients undergo stigmatisation, they do not revceive necessarypain medication and suffer unnecessarily. Inthis review, the published literature is presented and the arguments pro and con MOH are discussed.

Schlüsselwörter

Chronischer Kopfschmerz - Kopfschmerz bei Medikamentenübergebrauch - Migräne - Kopfschmerz vom Spannungstyp.

Keywords

Chronic headache - medication overuse headache,migraine - tension-type headache
 

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