Leitlinie zur Diagnostik, Therapie und Prophylaxe von Cluster-Kopfschmerz, anderen trigeminoautonomen Kopfschmerzen, schlafgebundenem Kopfschmerz und idiopathisch stechenden Kopfschmerzen

 

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Zusammenfassung

Nach der 2013 überarbeiteten IHS-Klassifikation werden der episodische und chronische Cluster-Kopfschmerz, die episodisch und chronisch paroxysmale Hemikranie und SUNCT-Syndrom (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing) und das SUNA-Syndrom (short-lasting unilateral neuralgiform headache with autonomic symptoms) sowie die Hemicrania continua unter dem Begriff trigemino-autonome Kopfschmerzen (TAK) zusammengefasst. Sie unterscheiden sich in Dauer, Frequenz und Rhythmik der Schmerzattacken. Autonome Begleitsymptome wie ipsilaterale Lakrimation, konjunktivale Injektion, Rhinorrhoe, nasale Kongestion, Gesichtsschwitzen, Völlegefühl im Ohr und Lidschwellung treten mehr oder weniger stark ausgeprägt auf. Ein wesentliches weiteres Unterscheidungsmerkmal liegt in dem unterschiedlichen Ansprechen auf Indometacin: Der Cluster-Kopfschmerz und das SUNCT- und SUNA-Syndrom sprechen nicht auf Indometacin an, bei den anderen TAK ist Indometacin per definitionem effektiv. Grundsätzlich unterteilt sich die Therapie der TAK in eine Akuttherapie und eine medikamentöse Prophylaxe. Aufgrund der relativen Kürze der Attacken ist bei der paroxysmalen Hemicranie und beim SUNCT/SUNA-Syndrom keine Akuttherapie möglich, beim Cluster-Kopfschmerz sind orale Substanzen in der Regel nicht ausreichend rasch wirksam. Das größte Augenmerk der Therapie liegt daher stets auf der Prophylaxe. Die Therapie der TAK erfordert eine individuell auf den Patienten zugeschnittene Kombination der verschiedenen Therapieoptionen. Obwohl ausreichend gute, vergleichende Studien rar sind, kann in der Praxis in der Mehrzahl der Fälle eine positive Beeinflussung der Schmerzattacken erreicht werden. Nur in seltenen Fällen ist eine invasive Therapie nötig. Die Therapieempfehlungen stützen sich, soweit möglich, auf Kriterien der evidenzbasierten Medizin (EBM).

Summary

Following the 2013 IHS-classification, cluster headache, paroxysmal hemicrania, hemicrania continua and short-lasting unilateral neuralgiform headache with autonomic symptoms (SUNA) and conjunctival injection and tearing (SUNCT) are included into the classification as trigemino-autonomic cephalgias (TAC). The similarities of these syndromes suggest a considerable shared pathophysiology. These syndromes have in common that they involve activation of trigeminovascular nociceptive pathways with reflex cranial autonomic activation. Clinically, this physiology predicts pain with some combination of ipsilateral lacrimation, conjunctival injection, nasal congestion, facial sweating or eyelid oedema. Broadly the management of TAC comprises acute and prophylactic treatment. Some types of trigemino-autonomic headaches, such as paroxysmal hemicrania and hemicrania continua have, unlike cluster headaches, a very robust response to indometacin, leading to a consideration of indometacin-sensitive headaches. This review covers the clinical picture and therapeutic options. Although studies following the criteria of evidence based medicine (EBM) are rare, most patients can be treated sufficiently. In medically intractable patients promising invasive treatments have emerged.

• Literatur

• 1 Andersson PG, Jespersen LT. Dihydroergotamine nasal spray in the treatment of attacks of cluster headache. A double-blind trial versus placebo. Cephalalgia 1986; 6: 51-4.
  CrossrefPubMedGoogle Scholar
• 2 Antonaci F, Sjaastad O. Chronic paroxysmal hemicrania (CPH): a review of the clinical manifestations. Headache 1989; 29: 648-56.
  CrossrefPubMedGoogle Scholar
• 3 Bahra A, Goadsby PJ. Diagnostic delays and mismanagement in cluster headache. Acta Neurol Scand 2004; 109: 175-9.
  CrossrefPubMedGoogle Scholar
• 4 Bahra A, May A, Goadsby PJ. Cluster headache: A prospective clinical study with diagnostic implications. Neurology 2002; 58: 354-61.
  CrossrefPubMedGoogle Scholar
• 5 Bennett MH, French C, Schnabel A, Wasiak J, Kranke P. Normobaric and hyperbaric oxygen therapy for migraine and cluster headache. Cochrane Database Syst Rev. 2008 CD005219.
  PubMedGoogle Scholar
• 6 Burns B, Watkins L, Goadsby PJ. Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 2007; 369: 1099-106.
  CrossrefPubMedGoogle Scholar
• 7 Cittadini E, May A, Straube A, Evers S, Bussone G, Goadsby PJ. Effectiveness of intranasal zolmitriptan in acute cluster headache: a randomized, placebo-controlled, double-blind crossover study. Arch Neurol 2006; 63: 1537-42.
  CrossrefPubMedGoogle Scholar
• 8 Cohen A, Matharu M, Goadsby P. ECG abnormalities on verapamil in cluster headache. Cephalalgia 2005; 25: 1200.
  Google Scholar
• 9 Cohen AS, Burns B, Goadsby PJ. High-flow oxygen for treatment of cluster headache: a randomized trial. Jama 2009; 302: 2451-7.
  CrossrefPubMedGoogle Scholar
• 10 Ekbom K. Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society. Cephalalgia 1990; 10: 195-7.
  CrossrefPubMedGoogle Scholar
• 11 Ekbom K. Lithium for cluster headache: review of the literature and preliminary results of long-term treatment. Headache 1981; 21: 132-9.
  CrossrefPubMedGoogle Scholar
• 12 Ekbom K. Treatment of acute cluster headache with sumatriptan. N Eng J Med 1991; 322-326.
  PubMedGoogle Scholar
• 13 Ekbom K, Monstad I, Prusinski A, Cole JA, Pilgrim AJ, Noronha D. Subcutaneous sumatriptan in the acute treatment of cluster headache: a dose comparison study. The Sumatriptan Cluster Headache Study Group. Acta Neurol Scand 1993; 88: 63-9.
  PubMedGoogle Scholar
• 14 Evers S, Goadsby PJ. Hypnic headache: clinical features, pathophysiology, and treatment. Neurology 2003; 60: 905-9.
  CrossrefPubMedGoogle Scholar
• 15 Favoni V, Grimaldi D, Pierangeli G, Cortelli P, Cevoli S. SUNCT/SUNA and neurovascular compression: new cases and critical literature review. Cephalalgia Int J Headache 2013; 33: 1337-1348.
  CrossrefPubMedGoogle Scholar
• 16 Fontaine D, Lanteri-Minet M, Ouchchane L, Lazorthes Y, Mertens P, Blond S, Geraud G, Fabre N, Navez M, Lucas C, Dubois F, Sol JC, Paquis P, Lemaire JJ. Anatomical location of effective deep brain stimulation electrodes in chronic cluster headache. Brain 2010; 133: 1214-23.
  CrossrefPubMedGoogle Scholar
• 17 Fontaine D, Lazorthes Y, Mertens P, Blond S, Geraud G, Fabre N, Navez M, Lucas C, Dubois F, Gonfrier S, Paquis P, Lanteri-Minet M. Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension. J Headache Pain 2010; 11: 23-31.
  CrossrefPubMedGoogle Scholar
• 18 Gallagher RM, Mueller LL, Freitag FG. Divalproex sodium in the treatment of migraine and cluster headaches. J Am Osteopath Assoc 2002; 102: 92-4.
  PubMedGoogle Scholar
• 19 Gaul C, Christmann N, Schröder D, Weber R, Shanib H, Diener HC, Holle D. Differences in clinical characteristics and frequency of accompanying migraine features in episodic and chronic cluster headache. Cephalalgia Int J Headache 2012; 32: 571-577.
  CrossrefPubMedGoogle Scholar
• 20 Gaul C, Diener H-C, Silver N, Magis D, Reuter U, Andersson A, Liebler EJ, Straube A. PREVA Study Group. Non-invasive vagus nerve stimulation for PREVention and Acute treatment of chronic cluster headache (PREVA): A randomised controlled study. Cephalalgia Int J Headache. 2015 epub ahead of print.
  PubMedGoogle Scholar
• 21 Gaul C, Holle D, May A. (Update on trigeminal autonomic cephalalgia). Nervenarzt 2013; 84: 1451-1459.
  CrossrefPubMedGoogle Scholar
• 22 Gaul C, Jürgens T. Frovatriptan for Prophylactic Treatment of Cluster Headache. Headache J Head Face Pain 2011; 51: 1008-1009.
  CrossrefPubMedGoogle Scholar
• 23 Goadsby PJ. Lacrimation, conjunctival injection, nasal symptoms. cluster headache, migraine and cranial autonomic symptoms in primary headache disorders – what’s new?. J Neurol. Neurosurg Psychiatry 2009; 80: 1057-1058.
  PubMedGoogle Scholar
• 24 Goadsby PJ, Cittadini E, Burns B, Cohen AS. Trigeminal autonomic cephalalgias: diagnostic and therapeutic developments. Curr Opin Neurol 2008; 21: 323-30.
  CrossrefPubMedGoogle Scholar
• 25 Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 1997; 120: 193-209.
  CrossrefPubMedGoogle Scholar
• 26 Goadsby PJ, Schoenen J, Ferrari MD, Silberstein SD, Dodick D. Towards a definition of intractable headache for use in clinical practice and trials. Cephalalgia 2006; 26: 1168-70.
  CrossrefPubMedGoogle Scholar
• 27 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia Int J Headache 2013; 33: 629-808.
  CrossrefPubMedGoogle Scholar
• 28 Holle D, Naegel S, Obermann M. Hypnic headache. Cephalalgia Int J Headache 2013; 33: 1349-1357.
  CrossrefPubMedGoogle Scholar
• 29 Jürgens TP, Schoenen J, Rostgaard J, Hillerup S, Láinez MJ, Assaf AT, May A, Jensen RH. Stimulation of the sphenopalatine ganglion in intractable cluster headache: Expert consensus on patient selection and standards of care. Cephalalgia Int J Headache 2014; 34 (13) 1100-10.
  CrossrefPubMedGoogle Scholar
• 30 Jürgens TP, Schulte LH, May A. Oxygen treatment is effective in migraine with autonomic symptoms. Cephalalgia Int J Headache 2013; 33: 65-67.
  CrossrefPubMedGoogle Scholar
• 31 Law S, Derry S, Moore RA. Triptans for acute cluster headache. Cochrane Database Syst Rev. 2013 7. CD008042.
  PubMedGoogle Scholar
• 32 Leone M, Attanasio A, Croci D, D’Amico D, Grazzi L, Ferraris A, Nespolo A, Bussone G. Neuroendocrinology of cluster headache. Ital J Neurol Sci 1999; 20: S18-S20.
  CrossrefPubMedGoogle Scholar
• 33 Leone M, Franzini A, Broggi G, May A, Bussone G. Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache. Brain 2004; 127: 2259-64.
  CrossrefPubMedGoogle Scholar
• 34 Leone M, Franzini A, Cecchini AP, Mea E, Broggi G, Bussone G. Cluster headache: pharmacological treatment and neurostimulation. Nat Clin Pr Neurol 2009; 5: 153-62.
  Google Scholar
• 35 Leroux E, Valade D, Taifas I, Vicaut E, Chagnon M, Roos C, Ducros A. Suboccipital steroid injections for transitional treatment of patients with more than two cluster headache attacks per day: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2011; 10: 891-897.
  CrossrefPubMedGoogle Scholar
• 36 Magis D, Allena M, Bolla M, De Pasqua V, Remacle JM, Schoenen J. Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study. Lancet Neurol 2007; 6: 314-21.
  CrossrefPubMedGoogle Scholar
• 37 Manzoni GC, Maffezzoni M, Lambru G, Lana S, Latte L, Torelli P. Late-onset cluster headache: some considerations about 73 cases. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol 2012; 33 (Suppl. 01) S157-159.
  Google Scholar
• 38 Markley HG. Topical agents in the treatment of cluster headache. Curr Pain Headache Rep 2003; 7: 139-43.
  CrossrefPubMedGoogle Scholar
• 39 Marmura MJ, Pello SJ, Young WB. Interictal pain in cluster headache. Cephalalgia 2010; 30: 1531-4.
  CrossrefPubMedGoogle Scholar
• 40 Martelletti P, Jensen RH, Antal A, Arcioni R, Brighina F, de Tommaso M, Franzini A, Fontaine D, Heiland M, Jürgens TP, Leone M, Magis D, Paemeleire K, Palmisani S, Paulus W, May A. Neuromodulation of chronic headaches: position statement from the European Headache Federation. J Headache Pain 2013; 14: 86.
  CrossrefPubMedGoogle Scholar
• 41 Matharu MS, Boes CJ, Goadsby PJ. Management of trigeminal autonomic cephalgias and hemicrania continua. Drugs 2003; 63: 1637-77.
  CrossrefPubMedGoogle Scholar
• 42 Matharu MS, Cohen AS, Boes CJ, Goadsby PJ. Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review. Curr Pain Headache Rep 2003; 7: 308-18.
  CrossrefPubMedGoogle Scholar
• 43 Matharu MS, Levy MJ, Meeran K, Goadsby PJ. Subcutaneous octreotide in cluster headache: Randomized placebo-controlled double-blind crossover study. Ann Neurol 2004; 56: 488-494.
  CrossrefPubMedGoogle Scholar
• 44 May A. Cluster headache: pathogenesis, diagnosis, and management. Lancet 2005; 366: 843-55.
  CrossrefPubMedGoogle Scholar
• 45 May A. Diagnosis and clinical features of trigemino-autonomic headaches. Headache 2013; 53: 1470-1478.
  CrossrefPubMedGoogle Scholar
• 46 May A. Pearls and pitfalls: Neuroimaging in headache. Cephalalgia Int J Headache 2013; 33: 554-565.
  CrossrefPubMedGoogle Scholar
• 47 May A, Bahra A, Buchel C, Frackowiak RS, Goads-by PJ. PET and MRA findings in cluster headache and MRA in experimental pain. Neurology 2000; 55: 1328-35.
  CrossrefPubMedGoogle Scholar
• 48 May A, Dodick D. Headache research: A string of pearls. Cephalalgia Int J Headache 2013; 33: 505.
  CrossrefPubMedGoogle Scholar
• 49 May A, Evers S, Straube A, Pfaffenrath V, Diener H. Therapie und Prophylaxe von Cluster Kopfschmerzen und anderen Trigemino-Autonomen Kopfschmerzen. Überarbeitete Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft Nervenheilkunde 2004; 23: 478-490.
  Google Scholar
• 50 May A, Straube A, Peikert A, Pfaffenrath V, Sandor P, Lampl C, Woeber C, Diener H. Diagnostik und apparative Zusatzuntersuchungen bei Kopfschmerzen. Stuttgart: Thieme; 2008
  Google Scholar
• 51 McGeeney BE. Topiramate in the treatment of cluster headache. Curr Pain Headache Rep 2003; 7: 135-8.
  CrossrefPubMedGoogle Scholar
• 52 Nagy AJ, Gandhi S, Bhola R, Goadsby PJ. Intravenous dihydroergotamine for inpatient management of refractory primary headaches. Neurology 2011; 77: 1827-1832.
  CrossrefPubMedGoogle Scholar
• 53 Nesbitt AD, Marin JCA, Tompkins E, Ruttledge MH, Goadsby PJ. Initial use of a novel noninvasive vagus nerve stimulator for cluster headache treatment. Neurology 2015; 84: 1249-1253.
  CrossrefPubMedGoogle Scholar
• 54 Paemeleire K, Bahra A, Evers S, Matharu MS, Goadsby PJ. Medication-overuse headache in patients with cluster headache. Neurology 2006; 67: 109-13.
  CrossrefPubMedGoogle Scholar
• 55 Pageler L, Katsarava Z, Lampl C, Straube A, Evers S, Diener HC, Limmroth V. Frovatriptan for prophylactic treatment of cluster headache: lessons for future trial design. Headache 2010; 51: 129-34.
  PubMedGoogle Scholar
• 56 Pareja JA, Ruiz J, de Isla C, al-Sabbah H, Espejo J. Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia 1996; 16: 93-6.
  CrossrefPubMedGoogle Scholar
• 57 Peres MF, Rozen TD. Melatonin in the preventive treatment of chronic cluster headache. Cephalalgia 2001; 21: 993-5.
  CrossrefPubMedGoogle Scholar
• 58 Pringsheim T, Magnoux E, Dobson CF, Hamel E, Aube M. Melatonin as adjunctive therapy in the prophylaxis of cluster headache: a pilot study. Headache 2002; 42: 787-92.
  CrossrefPubMedGoogle Scholar
• 59 Schoenen J, Jensen RH, Lantéri-Minet M, Láinez MJ, Gaul C, Goodman AM, Caparso A, May A. Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: A randomized, sham-controlled study. Cephalalgia Int J Headache 2013; 33 (10) 816-30.
  CrossrefPubMedGoogle Scholar
• 60 Schurks M, Kurth T, de Jesus J, Jonjic M, Rosskopf D, Diener HC. Cluster headache: clinical presentation, lifestyle features, and medical treatment. Headache 2006; 46: 1246-54.
  CrossrefPubMedGoogle Scholar
• 61 Schytz HW, Barløse M, Guo S, Selb J, Caparso A, Jensen R, Ashina M. Experimental activation of the sphenopalatine ganglion provokes cluster-like attacks in humans. Cephalalgia Int J Headache 2013; 33 (10) 831-41.
  CrossrefPubMedGoogle Scholar
• 62 Silberstein SD, Schulman EA, Hopkins MM. Repetitive intravenous DHE in the treatment of refractory headache. Headache 1990; 30: 334-9.
  CrossrefPubMedGoogle Scholar
• 63 Sjaastad O. Cluster Headache Syndrome. London: W B Saunders Company Ltd; 1992
  Google Scholar
• 64 Sjaastad O, Bakketeig LS. Cluster headache prevalence. Vaga study of headache epidemiology. Cephalalgia 2003; 23: 528-33.
  CrossrefPubMedGoogle Scholar
• 65 Sjaastad O, Pettersen H, Bakketeig LS. The Vaga study; epidemiology of headache I: the prevalence of ultrashort paroxysms. Cephalalgia 2001; 21: 207-15.
  CrossrefPubMedGoogle Scholar
• 66 Stochino ME, Deidda A, Asuni C, Cherchi A, Manchia M, Del Zompo M. Evaluation of lithium response in episodic cluster headache: a retrospective case series. Headache 2012; 52: 1171-1175.
  CrossrefPubMedGoogle Scholar
• 67 Tronvik E, Wienecke T, Monstad I, Dahløf C, Bøe MG, Tjensvoll AB, Salvesen R, Zwart JA, Jansson S-O, Stovner LJ. Randomised trial on episodic cluster headache with an angiotensin II receptor blocker. Cephalalgia 2013; 33: 1026-1034.
  CrossrefPubMedGoogle Scholar
• 68 Zhu S, McGeeney B. When indomethacin fails: additional treatment options for “indomethacin responsive headaches.”. Curr Pain Headache Rep 2015; 19: 7.
  CrossrefPubMedGoogle Scholar