Zusammenfassung
Die Klassifikation der Internationalen Kopfschmerzgesellschaft (IHS) unterteilt Kopfschmerzen in episodische und chronische Formen. Die chronische Migräne ist definiert als Kopfschmerzen an mehr als 15 Tagen im Monat für einen Zeitraum von mehr als 3 Monaten, wobei der Kopfschmerz an 8 oder mehr Tagen die Kriterien für eine Migräne erfüllen muss oder erfolgreich mit Triptanen oder Ergotaminpräparaten behandelbar war. Die Prävalenz der chronischen Migräne liegt zwischen 2 und 4 %. Die chronische Migräne schränkt die Lebensqualität massiv ein und es bestehen erheblich mehr Komorbiditäten als bei der episodischen Migräne. Es gibt nur wenig prospektive randomisierte Studien zur Behandlung der chronischen Migräne, da die meisten Patienten mit chronischer Migräne aus früheren Therapiestudien ausgeschlossen wurden. Wissenschaftlich belegt sind die Wirkungen von Topiramat und Botulinum-Toxin als Prophylaktika.
Summary
The classification of the International Headache Society (IHS) generally differentiates episodic from chronic headache. Chronic migraine is defined as headache on 15 and more days a month over more than 3 months and headache on 8 days or more fulfils the criteria for migraine or were triptan/ergot-responsive when thought to be migrainous in early stages of the attack. The prevalence of chronic migraine is estimated at 2-4 %. The quality of life is highly compromised in this condition and comorbidities are much more frequent compared to episodic migraine. Data from prospective randomized studies are scarce as most patients with chronic migraine were excluded from previous trials and only few studies were conducted for this condition. The efficacy for prophylactic treatment compared with placebo is proven for topiramate and onabotulinum toxin A.
Literatur
Afridi SK, Giffin NJ (2005) A positron emission tomographic study in spontaneous migraine. Arch Neurol 62(8):1270–1275
Aoki KR (2005) Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology 26(5):785–793
Aurora SK (2009) Is chronic migraine one end of a spectrum of migraine or a separate entity? Cephalalgia 29(6):597–605
Aurora SK, Dodick DW, Turkel CC et al (2010) Onabotulinum Toxin A for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia 30(7):793–803
Aurora SK (2009) Spectrum of illness Understanding biological patterns and relationships in chronic migraine. Neurology 72(5 Suppl 1):S8–S13
Bahra A, Matharu M, Buchel C et al (2001) Brainstem activation specific to migraine headache. Lancet 357(9261):1016–1017
Bartolini M, Silvestrini M, Taffi R et al (2005) Efficacy of topiramate and valproate in chronic migraine. Clin Neuropharmacol 28(6):277–279
Beran RG, Spira PJ (2011) Levetiracetam in chronic daily headache: a double-blind, randomised placebo-controlled study. (The Australian KEPPRA Headache Trial [AUS-KHT]). Cephalalgia 31(5):530–536
Burstein R (2001) Deconstructing migraine headache into peripheral and central sensitization. Pain 89(2–3):107–110
Cady RK, Schreiber CP, Porter JA et al (2011) A multi-center double-blind pilot comparison of onabotulinumtoxinA and topiramate for the prophylactic treatment of chronic migraine. Headache J Head Face Pain 51(1):21–32
Diener HC, Dodick DW, Aurora SK et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 30(7):804–814
Diener H-C, Bussone G, Oene JCV et al (2007) Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 27(7):814–823
Diener H-C, Dodick DW, Goadsby PJ et al (2009) Utility of topiramate for the treatment of patients with chronic migraine in the presence or absence of acute medication overuse. Cephalalgia 29(10):1021–1027
Dodick DW, Turkel CC, DeGryse RE et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache J Head Face Pain 50(6):921–936
Felice M De, Porreca F (2009) Opiate-induced persistent pronociceptive trigeminal neural adaptations: potential relevance to opiate-induced medication overuse headache. Cephalalgia 29(12):1277–1284
Felice M De, Ossipov MH, Wang R et al (2010) Triptan-induced latent sensitization: a possible basis for medication overuse headache. Ann Neurol 67(3):325–337
Gazerani P, Staahl C, Drewes AM, Arendt-Nielsen L (2006) The effects of botulinum toxin type A on capsaicin-evoked pain, flare, and secondary hyperalgesia in an experimental human model of trigeminal sensitization. Pain 122(3):315–325
Headache Classification Committee of the International Headache Society (IHS) (2013) The International Classification of Headache Disorders, 3rd edn (beta version). Cephalalgia Int J Headache 33(9):629–808
Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edition. Cephalalgia Int J Headache 24(Suppl 1):9–160
Krymchantowski AV, Silva MT, Barbosa JS, Alves LA (2002) Amitriptyline versus amitriptyline combined with fluoxetine in the preventative treatment of transformed migraine: a double-blind study. Headache J Head Face Pain 42(6):510–514
Linde M, Stovner LJ, Zwart J-A, Hagen K (2011) Time trends in the prevalence of headache disorders. The Nord-Trøndelag Health Studies (HUNT 2 and HUNT 3) Cephalalgia 31(5):585–596
Manack A, Buse DC, Serrano D et al (2011) Rates, predictors, and consequences of remission from chronic migraine to episodic migraine. Neurology 76(8):711–718
Matharu MS, Bartsch T, Ward N et al (2004) Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 127(1):220–230
Mathew NT, Jaffri SFA (2009) A double-blind comparison of onabotulinumtoxina (BOTOX®) and topiramate (TOPAMAX®) for the prophylactic treatment of chronic migraine: a pilot study. Headache J Head Face Pain 49(10):1466–1478
Natoli JL, Manack A, Dean B et al (2010) Global prevalence of chronic migraine: a systematic review. Cephalalgia Int J Headache 30(5):599–609
Saper JR, Silberstein SD, Lake AE 3rd, Winters ME (1994) Double-blind trial of fluoxetine: chronic daily headache and migraine. Headache 34(9):497–502
Saper JR, Dodick DW, Silberstein SD et al (2011) Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalalgia Int J Headache 31(3):271–285
Saper JR, Lake AE 3rd, Cantrell DT et al (2002) Chronic daily headache prophylaxis with tizanidine: a double-blind, placebo-controlled, multicenter outcome study. Headache 42(6):470–482
Scher AI, Stewart WF, Ricci JA, Lipton RB (2003) Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain 106(1):81–89
Silberstein SD, Dodick DW, Lindblad AS et al (2012) Randomized, placebo-controlled trial of propranolol added to topiramate in chronic migraine. Neurology 78(13):976–984
Silberstein SD, Lipton RB (1997) Headache. In: Goadsby PJ, Silberstein SD (Hrsg) Butterworth-Heinemann, Boston, S 201–225
Silberstein SD, Dodick DW, Saper J et al (2012) Safety and efficacy of peripheral nerve stimulation of the occipital nerves for the management of chronic migraine: results from a randomized, multicenter, double-blinded, controlled study. Cephalalgia Int J Headache 32(16):1165–1179
Silberstein S, Lipton R, Dodick D et al (2009) Topiramate treatment of chronic migraine: a randomized, placebo-controlled trial of quality of life and other efficacy measures. Headache 49(8):1153–1162
Spira PJ, Beran RG (2003) Gabapentin in the prophylaxis of chronic daily headache A randomized, placebo-controlled study. Neurology 61(12):1753–1759
Vikelis M, Rapoport AM (2010) Role of antiepileptic drugs as preventive agents for migraine. Cns Drugs 24(1):21–33
Weiller C, May A, Limmroth V et al (1995)Brain stem activation in spontaneous human migraine attacks. Nat Med 1(7):658–660
Zagami AS, Lambert GA (1990) Stimulation of cranial vessels excites nociceptive neurones in several thalamic nuclei of the cat. Exp Brain Res 81(3):552–566
International Headache Society (2009) 14th Congress of the International Headache Society. September 10–13, 2009 Philadelphia, PA. Cephalalgia 29(1 Suppl):1–166
Silberstein et al (2007) Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind, placebo-controlled trial. Headache47(2):170–180
Einhaltung ethischer Richtlinien
Interessenkonflikt. H.C. Diener erhielt Honorare für die Planung, Ausführung oder Teilnahme an klinischen Studien, Teilnahme an Advisory Boards oder Vorträge von: Addex Pharma, Allergan, Almirall, AstraZeneca, Bayer Vital, Berlin Chemie, Boehringer Ingelheim, Bristol Myers Sqibb, Colucid, Coherex, GlaxoSmithKline, Grünenthal, Janssen-Cilag, Lilly, La Roche, 3M Media, Menerini, Minster, MSD, Neuroscore, Novartis, Johnson & Johnson, Pierre Fabre, Pfizer, Schaper an Brümmer, Sanofi, St. Jude Medical und Weber & Weber. Finanzielle Unterstützung für Forschungsprojekte wurde gewährt von: Allergan, Almirall, AstraZeneca, Bayer, GSK, Janssen-Cilag, MSD und Pfizer. Kopfschmerzforschung an der Universitätsklinik für Neurologie und dem Westdeutschen Kopfschmerzzentrum Essen erfolgte durch: Deutsche Forschungsgemeinschaft (DFG), Bundesministerium für Bildung und Forschung (BMBF) und die Europäische Unio (EU). HCD besitzt keine Aktien oder Anteile von Pharmafirmen. D. Holle erhielt finanzielle Unterstützung für Forschungsprojekte von Allergan sowie eine Wissenschaftliches Stipendium von der Fa. Grünenthal. D. Müller: keine Interessenkonflikte. S. Nägel: keine Interessenkonflikte. K. Rabe erhielt Honorare für Vorträge von der Fa. Allergan. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Diener, H., Holle, D., Müller, D. et al. Chronische Migräne. Nervenarzt 84, 1460–1466 (2013). https://doi.org/10.1007/s00115-012-3625-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00115-012-3625-3