Zusammenfassung
Der Kopfschmerz vom Spannungstyp (KST) ist die häufigste Form primärer Kopfschmerzen. Mit einer Jahresprävalenz von etwa 40 % hat der KST eine herausragende klinische und sozioökonomische Bedeutung. Gleichzeitig ist der KST der am wenigsten untersuchte Kopfschmerz mit infolgedessen weitgehend unklarer Pathophysiologie. Die wesentliche Ursache für diese Diskrepanz zwischen medizinischer Relevanz und wissenschaftlichem Neglekt ist das Fehlen eines geeigneten Tiermodells. Ausgehend von dem Leitsymptom der gesteigerten Druckschmerzempfindlichkeit bei Patienten mit KST zielt das translationale Forschungsprojekt A3 des Deutschen Kopfschmerzkonsortiums auf ein Tiermodell zur Untersuchung der myofaszialen Nozizeption aus der Nackenmuskulatur. Bei Labormäusen in Allgemeinanästhesie werden Nozizeptoren der Nackenmuskeln durch intramuskuläre Injektionen von hypertoner Kochsalzlösung, Nervenwachstumsfaktor und Adenosintriphosphat (ATP) erregt. Der nozizeptive Impakt auf sensorische Neurone des Hirnstammes und des oberen Zervikalmarkes wird durch elektromyographische Ableitung des Kieferöffnungsreflexes bestimmt. Bilaterale Injektionen insbesondere von ATP führen beim Menschen zu tiefem Muskelschmerz und lokalem Spannungsgefühl und beim Versuchstier zu einer klaren Bahnung des Reflexes im Sinne einer zentralen Sensibilisierung. Eine Episode des KST dauert beim Patienten zwischen 30 Minuten und sieben Tagen. Die Reflexbahnung im Tierexperiment hält mindestens vier Stunden an. Das entwickelte Tiermodell ermöglicht die Untersuchung der Physiologie und Pharmakologie der myofaszialen Nozizeption im Nackenbereich und eröffnet neue Perspektiven zum Verständnis der Pathophysiologie und Therapie des KST.
Abstract
Tension-type headache (TTH) is the most frequent form of primary headache. A 1-year prevalence of approximately 40 % indicates the extreme clinical and socioeconomic importance of TTH. In contrast, the pathophysiology of TTH is still unknown due to the lack of major scientific interest. The main reason for the discrepancy between medical relevance and scientific neglect is the lack of an appropriate animal experimental model. The most significant abnormal finding in TTH patients is increased pericranial tenderness. Based on this finding the translational research project A3 of the German Headache Consortium addresses an animal model in order to investigate myofascial nociception from neck muscles. In mice under general anaesthesia muscle nociceptors are excited by intramuscular administration of hypertonic saline, nerve growth factor, and adenosine triphosphate (ATP). The nociceptive impact on sensory processing in the brainstem and upper cervical spinal cord is electromyographically monitored by the jaw-opening reflex. Bilateral intramuscular injections, especially of ATP, evoke deep muscle pain and local tenderness in man and strong reflex facilitation corresponding to central sensitisation in mice. TTH episodes in patients take between 30 minutes and seven days. Reflex facilitation in mice takes at least four hours. The developed animal model allows for an investigation of the physiology and pharmacology of myofascial nociceptive processing in the neck and may open up new vistas into the pathophysiology and treatment of TTH.
Schlüsselwörter
Nackenmuskel - Nozizeption - zentrale Sensibilisierung - Muskelschmerz - Hirnstamm
Key words
neck muscles - nociception - central sensitization - myofascial pain - brainstem
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Prof. Dr. med. Jens Ellrich
Center for Sensory-Motor Interaction SMI, Department of Health Science and Technology, Aalborg University
Fredrik Bajers Vej 7D3
9220 Aalborg, Denmark
Email: ellrichj@googlemail.com
