Anstrengungskopfschmerzen

Zusammenfassung

Unter Anstrengungskopfschmerzen werden seltene Kopfschmerzsyndrome wie Hustenkopfschmerzen, Kopfschmerzen bei körperlicher Anstrengung und Kopfschmerzen bei sexueller Aktivität zusammengefasst. Diese Syndrome zeigen eine Reihe von Gemeinsamkeiten wie das Auftreten während oder nach körperlicher Anstrengung, bestimmte Schmerzcharakteristika und das Ansprechen auf Indomethacin. Hustenkopfschmerzen treten nach abrupten Anstiegen des intraabdominellen Druckes auf, wohingegen Kopfschmerzen bei körperlicher Anstrengung und sexuelle Kopfschmerzen nach länger andauernder physischer Aktivität auftreten. Die Prävalenz dieser Syndrome liegt bei 1 %; zumeist sind Männer betroffen. Die Diagnose primärer Anstrengungskopfschmerzen ist eine Ausschlussdiagnose, da die Inzidenz symptomatischer Formen, z. B. im Rahmen von Subarachnoidalblutungen oder Arnold-Chiari-Malformationen Typ I sehr hoch ist und eine sorgfältige Ausschlussdiagnostik erforderlich ist. Die pathophysiologischen Mechanismen der primären Formen sind derzeit unklar. Ähnliche Auslösemechanismen wie z. B. ein plötzlicher Anstieg des intraabdominellen Druckes mit einer konsekutiven Erhöhung des intrakraniellen Druckes und Reizung schmerzsensibler Strukturen wie der Dura mater und intrakranielle venöse Sinus werden diskutiert.

Abstract

Headaches associated with sexual activity, cough and exertion are rare headache syndromes that show distinct but overlapping clinical features. Here, the current pathophysiological models that have facilitated our understanding of these headache types are reviewed. Although the exact pathophysiological mechanisms are yet to be defined, these headaches share the trigger mechanism of raised intra-abdominal pressure, with the sequelae of raised intracranial pressure leading to irritation of pain-sensitive intracranial structures such as the dura mater and venous sinus. The incidence of underlying symptomatic forms such as subarachnoid haemorrhage (SAH) or Chiari-I-Malformation is relatively high, so the importance of differential diagnosis and diagnostic evaluation of these headaches is discussed. The role of these headaches in the revised headache classification scheme of the International Headache Society (IHS) is considered. In view of recent clinical and experimental data highlighting the clinical spectrum of these headaches, current therapeutic options and prognostic outcome are explored.

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