Download PDF
Klin Padiatr 2019; 231(01): 14-20
DOI: 10.1055/a-0710-5014
Übersicht / Review
© Georg Thieme Verlag KG Stuttgart · New York

Chronische Kopfschmerzen bei Kindern und Jugendlichen

Chronic Headache in Children and Adolescents
Markus Blankenburg
1   Zentrum für Kinder- und Jugendmedizin Olgahospital, Pädiatrische Neurologie, Psychosomatik und Schmerztherapie, Kinderschmerzzentrum Baden-Württemberg, Stuttgart
2   Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Kinderschmerztherapie und pädiatrische Palliativmedizin
,
Michael Schroth
1   Zentrum für Kinder- und Jugendmedizin Olgahospital, Pädiatrische Neurologie, Psychosomatik und Schmerztherapie, Kinderschmerzzentrum Baden-Württemberg, Stuttgart
,
Sarah Braun
1   Zentrum für Kinder- und Jugendmedizin Olgahospital, Pädiatrische Neurologie, Psychosomatik und Schmerztherapie, Kinderschmerzzentrum Baden-Württemberg, Stuttgart
› Author Affiliations
Further Information

Publication History

Publication Date:
15 October 2018 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Primäre Kopfschmerzerkrankungen wie Spannungskopfschmerzen und Migräne beginnen in der Kindheit und werden mit der Einschulung und Pubertät häufiger. Bei Spannungskopf-schmerzen spielt die zentrale Schmerzsensibilisierung und Aktivierung zentraler nozizeptiver Neurone eine wichtige Rolle. Die Migräne ist eine primäre Erkrankung des Gehirns mit Auffälligkeiten schmerzmodulierender Systeme und der kortikalen Reizverarbeitung. Bei beiden Kopfschmerzformen spielen bio-psycho-soziale Faktoren eine entscheidende Rolle. Sekundäre Kopfschmerzen durch eine entzündliche oder strukturelle hirnorganische Ursache sind selten. Die Diagnose erfolgt anhand der Anamnese und der körperlichen Untersuchung sowie apparativer Untersuchungen bei Auffälligkeiten. Bei Spannungskopfschmerzen steht die multimodale Schmerztherapie im Vordergrund, bei Migräne die medikamentöse Therapie der Attacken und bei sekundären Kopfschmerzen die Behandlung der Grunderkrankung. Behandlungsziele sind die Minderung der Schmerzwahrnehmung, Förderung von Kontroll- und Selbstwirksamkeitserfahrungen, die Steigerung der körperlichen Leistungsfähigkeit sowie die Wiederaufnahme normaler Alltagsstrukturen und sozialer Kontakte als Voraussetzung für eine zunehmende Schmerzminderung.

Abstract

Primary headache disorders such as migraine and tension-type headache begin as early as childhood or adolescence. Prevalence increases during primary school and adolescence. In tension-type headache, central pain sensitization and activation of central nociceptive neurons plays an important role. Migraine is a primary brain disorder with abnormalities in pain modulating systems and cortical stimulus processing. Bio-psycho-social factors play a decisive role in both types of headache. Secondary headaches due to an inflammatory or a structural brain alteration are rare. Diagnosis is based on clinical criteria. Typical recurrent headaches are diagnosed by patient’s history and physical examination. In case of abnormalities, further diagnostic is needed. Treatment of tension-type headache is focused on multimodal pain therapy, treatment of migraine is focused on medication of attacks and secondary headaches need treatment of the underlying disease. Treatment goals are the reduction of pain perception, promotion of control and self-efficacy experiences, the increase of physical performance as well as the resumption of normal everyday structures and social contacts as a prerequisite for an increasing pain reduction.

Schlüsselwörter

Migräne - Spannungskopfschmerzen - chronische Schmerzstörung - multimodale Therapie - Kinder und Jugendliche

Key words

Migraine - tension-type headache - chronic pain disorder - multimodal treatment approach - children and adolescents
 

  • Literatur

  • 1 Abu-Arafeh I, Macleod S. Serious neurological disorders in children with chronic headache. Arch Dis Child 2005; 90: 937-940 doi:10.1136/adc.2004.067256
    CrossrefPubMedGoogle Scholar
  • 2 Anttila P, Metsahonkala L, Sillanpaa M. Long-term trends in the incidence of headache in Finnish schoolchildren. Pediatrics 2006; 117: e1197-e1201. doi:10.1542/peds.2005-2274
    CrossrefPubMedGoogle Scholar
  • 3 Bigal ME, Liberman JN, Lipton RB. Age-dependent prevalence and clinical features of migraine. Neurology 2006; 67: 246-251. doi:10.1212/01.wnl.0000225186.76323.69
    CrossrefPubMedGoogle Scholar
  • 4 Bonfert M, Straube A, Schroeder AS. et al. Primary headache in children and adolescents: update on pharmacotherapy of migraine and tension-type headache. Neuropediatrics 2013; 44: 3-19 doi: 10.1055/s-0032-1330856
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Brattberg G. Do pain problems in young school children persist into early adulthood? A 13-year follow-up. Eur J Pain 2004; 8: 187-199 doi: 10.1016/j.ejpain.2003.08.001
    CrossrefPubMedGoogle Scholar
  • 6 Di Lorenzo C, Grieco GS, Santorelli FM. Migraine headache: a review of the molecular genetics of a common disorder. J Headache Pain 2012; 13: 571-580. doi: 10.1007/s10194-012-0478-x
    CrossrefPubMedGoogle Scholar
  • 7 Dobe M, Damschen U, Reiffer-Wiesel B. et al. Three-week multimodal inpatient treatment of children with chronic pain. First results of the long-term follow-up. Schmerz 2006; 20: 51-60 doi: 10.1007/s00482-005-0457-0
    CrossrefPubMedGoogle Scholar
  • 8 Dobe M, Hechler T, Behlert J. et al. [Pain therapy with children and adolescents severely disabled due to chronic pain: long-term outcome after inpatient pain therapy]. Schmerz 2011; 25: 411-422. doi: 10.1007/s00482-011-1051-2
    CrossrefPubMedGoogle Scholar
  • 9 Dooley JM. The evaluation and management of paediatric headaches. Paediatr Child Health 2009; 14: 24-30
    CrossrefPubMedGoogle Scholar
  • 10 Due P, Holstein BE, Lynch J. et al. Bullying and symptoms among school-aged children: international comparative cross sectional study in 28 countries. Eur J Public Health 2005; 15: 128-132 doi: 10.1093/eurpub/cki105
    CrossrefPubMedGoogle Scholar
  • 11 Ebinger F, Kropp P, Pothmann R. et al. Therapie idiopathischer Kopfschmerzen im Kindes- und Jugendalter. Revidierte Empfehlungen der Gesellschaft für Neuropädiatrie (GNP) und der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG). Monatsschr Kinderheilkunde 2009; 599-610
    PubMedGoogle Scholar
  • 12 Evers S. Controlled trials in pediatric migraine: crossover versus parallel group. Curr Pain Headache Rep 2007; 11: 241-244
    CrossrefPubMedGoogle Scholar
  • 13 Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81: 1159-1165. doi: 10.1212/WNL.0b013e3182a55f17
    CrossrefPubMedGoogle Scholar
  • 14 Gassmann J, Vath N, van Gessel H. et al. Risk factors for headache in children. Dtsch Arztebl Int 2009; 106: 509-516. doi: 10.3238/arztebl.2009.0509
    PubMedGoogle Scholar
  • 15 Gaul C, Messlinger K, Holle-Lee D. et al. Pathophysiology of Headaches. Dtsch Med Wochenschr 2017; 142: 402-408. doi: 10.1055/s-0042-111694
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Gutjahr P. Tumoren des Zentralnervensystems in Krebs bei Kindern und Jugendlichen: Klinik und Praxis der Pädiatrischen Onkologie. 2004. 5. Aufl. Deutscher Ärzte-Verlag;
    Google Scholar
  • 17 Hamalainen ML, Hoppu K, Valkeila E. et al. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double-blind, randomized, placebo-controlled, crossover study. Neurology 1997; 48: 103-107
    CrossrefPubMedGoogle Scholar
  • 18 Hechler T, Dobe M, Kosfelder J. et al. Effectiveness of a 3-week multimodal inpatient pain treatment for adolescents suffering from chronic pain: statistical and clinical significance. Clin J Pain 2009; 25: 156-166 doi: 10.1097/AJP.0b013e318185c1c9
    CrossrefPubMedGoogle Scholar
  • 19 Hechler T, Ruhe A-K, Schmidt P. et al. Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects. Pain 2014; 155: 118-128. doi: 10.1016/j.pain.2013.09.015
    CrossrefPubMedGoogle Scholar
  • 20 Hershey AD, Powers SW, Nelson TD. et al. Obesity in the pediatric headache population: a multicenter study. Headache 2009; 49: 170-177 doi: 10.1111/j.1526-4610.2008.01232.x
    CrossrefPubMedGoogle Scholar
  • 21 Kanemura H, Sano F, Ishii S. et al. Characteristics of headache in children with epilepsy. Seizure 2013; 22: 647-650. doi: 10.1016/j.seizure.2013.04.022
    CrossrefPubMedGoogle Scholar
  • 22 Kedia S. Complementary and Integrative Approaches for Pediatric Headache. Semin Pediatr Neurol 2016; 23: 44-52 doi: 10.1016/j.spen.2016.01.010
    CrossrefPubMedGoogle Scholar
  • 23 King S, Chambers CT, Huguet A. et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011; 152: 2729-2738 doi: 10.1016/j.pain.2011.07.016
    CrossrefPubMedGoogle Scholar
  • 24 Kokki H, Lintula H, Vanamo K. et al. Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy. Arch Pediatr Adolesc Med 2005; 159: 320-325. doi: 10.1001/archpedi.159.4.320
    CrossrefPubMedGoogle Scholar
  • 25 Kors EE, Vanmolkot KRJ, Haan J. et al. Recent findings in headache genetics. Curr Opin Neurol 2004; 17: 283-288
    CrossrefPubMedGoogle Scholar
  • 26 Langemark M, Bach FW, Jensen TS. et al. Decreased nociceptive flexion reflex threshold in chronic tension-type headache. Arch Neurol 1993; 50: 1061-1064
    CrossrefPubMedGoogle Scholar
  • 27 Linder SL, Mathew NT, Cady RK. et al. Efficacy and tolerability of almotriptan in adolescents: a randomized, double-blind, placebo-controlled trial. Headache 2008; 48: 1326-1336. doi: 10.1111/j.1526-4610.2008.01138.x
    CrossrefPubMedGoogle Scholar
  • 28 Martin AL, McGrath PA, Brown SC. et al. Anxiety sensitivity, fear of pain and pain-related disability in children and adolescents with chronic pain. Pain Res Manag 2007; 12: 267-272
    PubMedGoogle Scholar
  • 29 May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol 2016; 12: 455-464 doi: 10.1038/nrneurol.2016.93
    CrossrefPubMedGoogle Scholar
  • 30 McGrath PA. Chronic daily headache in children and adolescents. Curr Pain Headache Rep 2001; 5: 557-566
    CrossrefPubMedGoogle Scholar
  • 31 Michalczyk K, Sullivan JE, Berkenbosch JW. Pretreatment with midazolam blunts the rise in intracranial pressure associated with ketamine sedation for lumbar puncture in children. Pediatr Crit Care Med 2013; 14: e149-e155 doi: 10.1097/PCC.0b013e3182720459
    CrossrefPubMedGoogle Scholar
  • 32 Milde-Busch A, Blaschek A, Borggrafe I. et al. Associations of diet and lifestyle with headache in high-school students: results from a cross-sectional study. Headache 2010; 50: 1104-1114 doi: 10.1111/j.1526-4610.2010.01706.x
    CrossrefPubMedGoogle Scholar
  • 33 Mortimer MJ, Kay J, Jaron A. Childhood migraine in general practice: clinical features and characteristics. Cephalalgia 1992; 12: 238-243 discussion 186. doi: 10.1046/j.1468-2982.1992.1204238.x
    CrossrefPubMedGoogle Scholar
  • 34 Olesen J. Clinical and pathophysiological observations in migraine and tension-type headache explained by integration of vascular, supraspinal and myofascial inputs. Pain 1991; 46: 125-132
    CrossrefPubMedGoogle Scholar
  • 35 Ozkan M, Teber ST, Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches. Pediatr Neurol 2012; 46: 154-157. doi: 10.1016/j.pediatrneurol.2011.11.016
    CrossrefPubMedGoogle Scholar
  • 36 Pelzer N, Haan J, Stam AH. et al. Clinical spectrum of hemiplegic migraine and chances of finding a pathogenic mutation. Neurology 2018; 90: e575-e582 10.1212/WNL.0000000000004966
    CrossrefPubMedGoogle Scholar
  • 37 Pinquart M, Shen Y. Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. J Pediatr Psychol 2011; 36: 375-384. doi: 10.1093/jpepsy/jsq104
    CrossrefPubMedGoogle Scholar
  • 38 Powers SW, Coffey CS, Chamberlin LA. et al. Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine. N Engl J Med 2017; 376: 115-124. doi: 10.1056/NEJMoa1610384
    CrossrefPubMedGoogle Scholar
  • 39 Robberstad L, Dyb G, Hagen K. et al. An unfavorable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology 2010; 75: 712-717. doi: 10.1212/WNL.0b013e3181eee244
    CrossrefPubMedGoogle Scholar
  • 40 Schoenen J. Wolff Award 1992. Exteroceptive suppression of temporalis muscle activity in patients with chronic headache and in normal volunteers: methodology, clinical and pathophysiological relevance. Headache 1993; 33: 3-17
    CrossrefPubMedGoogle Scholar
  • 41 Schroeder S, Hechler T, Denecke H. et al. German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ). A multimodal questionnaire for diagnosis and treatment of children and adolescents suffering from chronic pain. Schmerz 2010; 24: 23-37. doi: 10.1007/s00482-009-0864-8
    CrossrefPubMedGoogle Scholar
  • 42 Seng JS, Graham-Bermann SA, Clark MK. et al. Posttraumatic stress disorder and physical comorbidity among female children and adolescents: results from service-use data. Pediatrics 2005; 116: e767-e776 doi: 10.1542/peds.2005-0608
    CrossrefPubMedGoogle Scholar
  • 43 Sillanpaa M, Piekkala P, Kero P. Prevalence of headache at preschool age in an unselected child population. Cephalalgia 1991; 11: 239-242 doi: 10.1046/j.1468-2982.1991.1105239.x
    CrossrefPubMedGoogle Scholar
  • 44 Stang PE, Yanagihara PA, Swanson JW. et al. Incidence of migraine headache: a population-based study in Olmsted County, Minnesota. Neurology 1992; 42: 1657-1662
    CrossrefPubMedGoogle Scholar
  • 45 Straube A, Pfaffenrath V, Ladwig K-H. et al. Prevalence of chronic migraine and medication overuse headache in Germany – the German DMKG headache study. Cephalalgia 2010; 30: 207-213 doi: 10.1111/j.1468-2982.2009.01906.x
    CrossrefPubMedGoogle Scholar
  • 46 Tietjen GE, Brandes JL, Peterlin BL. et al. Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache 2010; 50: 32-41 doi: 10.1111/j.1526-4610.2009.01557.x
    CrossrefPubMedGoogle Scholar
  • 47 Vervoort T, Huguet A, Verhoeven K. et al. Mothers’ and fathers’ responses to their child’s pain moderate the relationship between the child’s pain catastrophizing and disability. Pain 2011; 152: 786-793 doi: 10.1016/j.pain.2010.12.010
    CrossrefPubMedGoogle Scholar
  • 48 Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000; 85: 317-332
    CrossrefPubMedGoogle Scholar
  • 49 Wager J, Zernikow B. Was ist Schmerz?. Monatsschr Kinderheilkd 2014; 162: 12-18. doi: 10.1007/s00112-013-2958-8
    CrossrefPubMedGoogle Scholar
  • 50 Williams K, Chambers M, Logan S. et al. Association of common health symptoms with bullying in primary school children. BMJ 1996; 313: 17-19
    CrossrefPubMedGoogle Scholar
  • 51 Winner P, Lewis D. Young adult and pediatric headache management. 2005. Hamilton: BC Decker Inc: BC Decker Inc.;
    Google Scholar
  • 52 Winner P, Rothner AD, Wooten JD. et al. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo-controlled, acute study. Headache 2006; 46: 212-222. doi: 10.1111/j.1526-4610.2006.00339.x
    CrossrefPubMedGoogle Scholar
  • 53 Zernikow B. Therapie von Schmerzstörungen im Kindes- und Jugendalter. 2013. Berlin Heidelberg: Springer;
    Google Scholar
  • 54 Zernikow B. Schmerztherapie bei Kindern, Jugendlichen und jungen Erwachsenen. 2015. Berlin Heidelberg: Springer;
    Google Scholar
  • 55 Zernikow B, Wager J, Hechler T. et al. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr 2012; 12: 54. doi: 10.1186/1471-2431-12-54
    CrossrefPubMedGoogle Scholar
  • 56 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders. 3rd edition Cephalalgia 2018; 38: 1-211 doi: 10.1177/0333102417738202
    PubMedGoogle Scholar