Neues bei Migräne und Kopfschmerzen

Zusammenfassung

In dieser Übersicht werden die neuesten Erkenntnisse zur Pathophysiologie, Akuttherapie und Prophylaxe von Kopfschmerzen dargestellt. Für die familiär hemiplegische Migräne wurde ein neuer Genlokus auf dem Chromosom 1 identifiziert, der eine Ionenpumpe in der Zellmembran kodiert. Triptane sind heute die Substanzen der ersten Wahl zur Behandlung schwerer Migräneattacken. In Studienpopulationen sind allerdings Analgetika wie Azetylsalizylsäure oder nichtsteroidale Antirheumatika fast genauso wirksam wie Triptane. Neu bei den Triptanen ist Zolmitriptan-Nasenspray, das rascher wirkt als die orale Applikation. Frovatriptan hat eine begrenzte Wirksamkeit und eine niedrige Rate wiederkehrender Kopfschmerzen. Neu untersucht in der Migräneprophylaxe sind retardierte Valproinsäure und Topiramat. Der mögliche Nutzen von Botulinumtoxin ist nicht ausreichend belegt. Zum ersten Mal wurde jetzt belegt, dass Metamizol bei der Therapie des episodischen Spannungskopfschmerzes wirksam ist. In der Prophylaxe spielen trizyklische Antidepressiva in Kombination mit Verhaltenstherapie weiterhin die wichtigste Rolle. Auch Triptane können zu medikamentinduzierten Dauerkopfschmerzen führen. Dies geschieht mit Triptanen rascher als mit Mutterkornalkaloiden. Der Entzug ist allerdings einfacher und rascher.

Abstract

This review summarizes recent new information about the pathophysiology, therapy and prevention of headache. Familial hemiplegic migraine can be caused by a mutation on chromosome 19. A new mutation, coding an ion channel pump, was recently identified on chromosome 1. Triptans are the drugs of first choice in severe migraine attacks. Up to now, clinical trials could, however, not show a clear superiority of triptans over aspirin or non-steroidal anti-inflammatory drugs. A new application of zolmitriptan is the nasal spray leading to a faster onset of efficacy than the oral application. Frovatriptan has a limited efficacy but a low recurrence rate. New in migraine prophylaxis are slow release valproic acid and topiramate. The benefit of local injections of botulinum toxin is not proven for the prophylaxis of migraine or tension headache. Metamizole (dipyrone) is effective in episodic tension headache. For the prevention of chronic tension-type headache tricyclic antidepressants in combination with stress management or muscle relaxation are most effective. Not only combination analgesics and ergots can lead to medication overuse headache but also triptans. Triptans lead to this headache after a shorter time interval than ergots. Withdrawal therapy is easier with triptans than with analgesics or ergots.

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