Neues zu Kopfschmerzen 2013 – ein Update

Zusammenfassung

Im letzten Jahr hat sich die Neuromodulation des N. occipitalis major aber auch des Ganglion shenopalatinum bei chronischer Migräne und therapierefraktärem Cluster-Kopfschmerz weiter etabliert. Obwohl diese neuen Therapieoptionen ihre Kinderkrankheiten noch nicht vollständig abgelegt haben, ergänzen sie das therapeutische Spektrum in der Therapie von sonst bereits austherapierten Patienten deutlich. Die Nervus occipitalis-Blockade erweist sich zunehmend als probate Therapie des episodischen Cluster-kopfschmerzes als Überrückung bis die klassischen Prophylaktika wie Verapamil, Topiramat und Lithium anfangen zu wirken. Darüber hinaus gibt es gerade in der akuten Migränetherapie zwar keine wirklich neuen Medikamente, aber es wurden einige interessante Arbeiten zur Wirksamkeit und Verträglichkeit von verschiedenen Kombinationstherapien vorgestellt. Die Kombination von Triptanen mit SSRI/SNRI zum Beispiel ist deutlich weniger risikobehaftet ein serotoninerges Syndrom auszulösen als theoretisch angenommen, so dass die ohnehin schon häufig angewandt Kombination dieser Medikamentengruppen sicher ist. Eine Kombination von mehreren Migränepophylaktika ist hingegen nicht sinnvoll da es keine bessere Wirkung erbringt als die Monotherapie.

Abstract

Neurostimulation of not only the greater occipital nerve (GON) but also the sphenopalatine ganglion has become more and more established as technique for the treatment of chronic migraine and treatment refractive chronic cluster headache. Even though, some technical issues remain to be solved in these new techniques, they considerably broaden the therapeutic spectrum for these chronic and otherwise therapy resistant patients. Blockade of the occipital nerve seems to be another very promissing option in the treatment of episodic cluster headache in order to bridge the time span until conventional prophylactic medication such as verapamil, lithium and topiramate starts to work. Moreover, there are a few new findings in acute migraine therapy, even though no new drug developments have made any further progress in this regard. Efficacy and safety data of combination therapy in acute migraine were provided and it was demonstrated that serotonergic syndrome following the combination of triptans and SSRI/SNRI is much less probable to occur than theoretically suspected. Combination of migraine prophylactic medications on the other hand does not seem reasonable as they do not have an additive efficacy compared to monotherapy.

Schlüsselwörter

Kopfschmerzen - Migräne - Spannungskopfschmerz - Cluster-Kopfschmerz - Trigeminusneuralgie

Keywords

headache - migraine - tension-type headache - cluster headache - trigeminal neuralgia

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