Neues bei Kopfschmerzen 2006

Zusammenfassung

Neue Untersuchungen zur Epidemiologie von Kopfschmerzen zeigen jetzt auch an größeren Populationen eine Assoziation der Migräne mit und ohne Aura mit Depression und Angsterkrankungen. Neu ist eine eindeutige Assoziation zwischen Migräne und Übergewicht, eine Häufung von Fibromyalgiesyndromen bei Frauen mit Migräne, eine erhöhte Prävalenz von Synkopen bei Migränepatienten und häufigere gastrointestinale Beschwerden. Der Zusammenhang zwischen offenem Foramen ovale (PFO) und Migräne mit Aura beruht wahrscheinlich auf einer gemeinsamen genetischen Disposition. Die erste randomisierte Studie zum Schirmchenverschluss eines PFO bei Migränepatienten verlief negativ. Eine neue Studie zeigte, dass nichtsteroidale Antirheumatika wie Diclofenac in löslicher Form deutlich besser wirken als in Tablettenform. Zwei weitere Studien belegen die Schwierigkeiten, die Wirksamkeit von Triptanen bei Jugendlichen und Heranwachsenden zu belegen. Dies beruht auf der hohen Plazeboantwortrate bei Jugendlichen. Neue Erkenntnisse gibt es zum möglichen Wirkungsmechanismus von Migräneprophylaktika. In Tierexperimenten konnte gezeigt werden, dass eine Langzeitgabe von Betablockern, Antiepileptika, trizyklischen Antidepressiva und Serotoninantagonisten zu einer Erniedrigung der Schwelle für eine kortikale spreading depression führt. Zwei Studien zur Akupunktur zeigten, dass Akupunktur genauso wirksam ist wie Scheinakupunktur und einer klassischen medikamentösen Prophylaxe nicht überlegen ist.

Abstract

Recent studies on the epidemiology of migraine have shown, in a large population, an association between migraine, depression and anxiety disorders. New comorbidities with migraine include obesity, fibromyalgia (in women with migraine), syncope and gastrointestinal disturbances. The association between migraine with aura and patent foramen ovale (PFO) is due to the shared inheritance of both conditions. A randomised trial in migraine patients with PFO comparing transcutaneous shunt occlusion versus a sham procedure failed with regard to the primary endpoint (cure of migraine). A recent study showed that soluble diclofenac is more effective than the same dose in a normal tablet. It still remains difficult to show the efficacy of triptans in children and adolescents. Part of this difficulty has to do with the very high placebo response in this age group. Animal experiments were able to elucidate a possible mode of action of drugs used for migraine prevention. Long-term treatment with beta-blockers, calcium channel blockers and antiepileptics increased the threshold to provoke cortical spreading depression in rats. Short-term treatment, however, had no effect. Two large-scale studies on acupuncture for the prevention of migraine showed that Chinese acupuncture is as effective as sham acupuncture and that both are as effective as medical therapy.

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