Botulinumtoxin bei Kopfschmerzen

Zusammenfassung

Bei chronischen Kopfschmerzerkrankungen ist die Wirksamkeit der zur Verfügung stehenden prophylaktischen Medikation oftmals unzureichend. Neue klinische Daten zeigen, dass Botulinumtoxin nicht nur bei muskulärer Überaktivität eingesetzt werden kann (z. B. bei Dystonie oder Spastik) sondern auch antinozizeptive Effekte besitzt. Für Onabotulinumtoxin A (Botox^®) und eingeschränkt auch Abobotulinumtoxin A (Dysport^®) liegen teilweise vielversprechende Ergebnisse für die Behandlung von Kopfschmerzerkrankungen vor. Bei Patienten mit chronischen Spannungskopfschmerzen sowie Patienten mit episodischer Migräne konnten wiederholt keine signifikanten Behandlungseffekte nachgewiesen werden. Bei Patienten mit chronischer Migräne mit und ohne begleitenden Medikamentenübergebrauch zeigte sich in verschiedenen Studien eine signifikante Abnahme der monatlichen Kopfschmerz- und Migränetage nach Injek­tion von Botulinumtoxin. Zudem zeigte sich eine deutliche Verbesserung der Lebensqualität. Die Therapie mit Botulinumtoxin war generell gut verträglich. Erste Studien zeigen auch eine gute Wirksamkeit von Botulinumtoxin in der Therapie der Trigeminusneuralgie. Bezüglich der Therapie trigeminoautonomer Kopfschmerzen liegen noch nicht genügend Daten vor, um diese abschließend beurteilen zu können.

Abstract

In many cases current prophylactic medication is not effective enough for treatment of chronic headache disorders. New data from controlled trials and case series suggest that botulinum toxin is effective not only for the treatment of muscular overactivity (e. g., dystonia or spasticity) but has also antinociceptive properties. Therefore, Onabotulinum toxin A (Botox^®) and to a lesser extent Abobotulinum toxin A (Dysport^®) show promising results regarding headache treatment. In patients with chronic tension type headache as well as in episodic migraneurs botulinum toxin was not effective for prophylactic therapy. Patients with chronic migraine with and without medication overuse showed a significant reduction of monthly headache and migraine days after injection of botulinum toxin. Additionally, a significant improvement of quality of life was observed. Injections of botulinum toxin were well tolerated. First studies report a prophylactic efficacy of botulinum toxin in the treatment of trigeminal neuralgia. With respect to trigeminoautonomic cephalagias more study data are needed for final evaluation.

Schlüsselwörter

Botulinumtoxin - chronische Migräne - Medikamenten­übergebrauch - Spannungskopfschmerz - Trigeminoautonome Kopfschmerzen

Keywords

botulinum toxin - chronic migraine - medication overuse - tension type headache - trigemino autonomic cephalagias

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