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Diagnose und Therapie des Kopfschmerzes vom Spannungstyp

Diagnostic and therapy of tension-type headache

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Der episodische Kopfschmerz vom Spannungstyp ist die häufigste primäre Kopfschmerzform, und die Lebenszeitprävalenz wird mit 78 % angegeben. Bedingt durch das häufig nur kurzeitige Auftreten, der nur geringen bis mäßig starken Intensität der holozephalen Kopfschmerzen und dem Fehlen von vegetativen Begleitsymptomen führt dieser Kopfschmerz nur selten zu einer ärztlichen Konsultation. Dagegen kann der chronische Kopfschmerz vom Spannungstyp, die Kopfschmerzen bestehen dann an mehr als 15 Tagen im Monat, zu einer erheblichen Einschränkung der Lebensqualität führen. Seine 1-Jahres-Prävalenz wird mit 1− 3 % angegeben. Für beide Formen gilt, dass ein allgemein akzeptiertes pathophysiologisches Konzept noch fehlt. Die Therapie besteht immer aus der Kombination von nichtmedikamentösen Maßnahmen wie Aufklärung, Sporttherapie und Entspannungsübungen und medikamentöser Therapie, meist in Form eines trizyklischen Antidepressivums oder eines Serotonin-Noradrenalin-Reuptake-Inhibitors (SNRIs). Die Kombinationstherapie ist signifikant wirkungsvoller als die Einzeltherapien. Dennoch ist der chronische Kopfschmerz vom Spannungstyp häufig ein therapeutisches Problem.

Abstract

Episodic headache of the tension type is the most prevalent primary headache with a lifetime prevalence of about 78 %. Clinical characteristics are a dull, moderate, holocephalic headache without accompanying autonomic or vegetative symptoms. The episodic tension-type headache often lasts only 30 min up to a maximum of a few days. In contrast to this clinically often undemanding headache, chronic tension-type headache can cause considerable disability in patients. The 1-year prevalence is 1–3 % of the population. All therapy strategies combine nonpharmaceutical therapy such as education of the patient, regular aerobic exercise, and psychological treatment (e.g., Jacobson’s progressive muscle relaxation etc.) with pharmaceutical treatment such as tricyclic antidepressants or combined serotonergic and noradrenergic antidepressants. Combination therapy has been proven to be more effective than singular strategies; however, the chronic tension-type headache still poses a therapeutic problem.

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Einhaltung ethischer Richtlinien

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A. Straube hat für Vorträge bzw. Teilnahme an Advisory-Boards Honorare von Allergan Pharma, Berlin Chemie, MSD, Desitin, St. Jude, Hormosan, Pfizer erhalten.

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  1. Neurologie der Universität München, Standort Klinikum Großhadern, 81377, München, Deutschland

    A. Straube

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Straube, A. Diagnose und Therapie des Kopfschmerzes vom Spannungstyp. Bundesgesundheitsbl. 57, 967–973 (2014). https://doi.org/10.1007/s00103-014-2001-9

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