Neues bei Kopfschmerzen

Zusammenfassung

Dieser Artikel gibt eine Übersicht über die neuesten relevanten Informationen zu Thema Kopf- und Gesichtsschmerzen. Epidemiologische Daten aus neuen Studien z. B. zum Zusammenhang von Migräne mit einem PFO, dem kardiovaskulären Risiko, dem Verhalten der Migränekopfschmerzen während und nach der Menopause und der Entwicklung von „White Matter Lesions“ und der Migräne Genetik werden berichtet. Zur Pathophysiologie der Migräne gibt es Neuigkeiten zur Aktivität des Hypothalamus während der Prodromalphase und dem Zusammenspiel von Hypothalamus und Hirnstamm. Bezüglich der Attackentherapie konnten im letzten Jahr aus Studien und Metanalysen neue Informationen zum Triptaneinsatz, der Behandlung der menstruellen Migränen und den hemiplegischen Migränevarianten generiert werden. Des Weiteren besteht Hoffnung für die bereits verloren geglaubte Substanzgruppe der CGRP (calcitoningene related peptide)-Antagonisten, da die bisherigen Studiendaten zu Ubrogepant keinen Hinweis auf Hepatotoxizität geben und die Wirksamkeit der Substanz belegen. Die Neuigkeiten zur Migräneprophylaxe konzentrieren sich größtenteils auf den Stand der Untersuchungen zur Behandlung mit monoklonalen Antikörpern gegen CGRP und dessen Rezeptor, aber auch weiter Studiendaten zu bekannten Migräneprophlaktika und neuen interessanten Ansätzen werden kompakt diskutiert. Des Weiteren werden Neuigkeiten bezüglich des Kopfschmerz bei Medikamentenübergebrauch und dem Kopfschmerz von Spannungstyp, ebenso wie für die trigeminoautonomen Kopfschmerzen, die Trigeminusneuralgie und den „Neu aufgetretenen täglichen Kopfschmerz“ übersichtlich dargestellt.

Abstract

A review of the latest and most relevant information on different disorders of head and facial pain is presented. News from epidemiologic studies regarding the relationship between migraine and patent foramen ovale, the cardiovascular risk in migraine, and migraine behavior during menopause, and the development of white matter lesions or migraine genetics are presented. Regarding pathophysiology there are very recent insights regarding the role of the hypothalamus during prodromal phase and the interplay of brain-stem and hypothalamus during the attack. In the last year studies and metaanalysis generated new knowledge for the use of triptans in general as in menstrual related migraine and hemiplegic variants. Furthermore, new hope rises for the CGRP (calcitonin-gene related peptide)-antagonists, as the data for ubrogepant do not suggest hepatotoxicity but efficacy. In prophylactic migraine treatment the news are manly on how the new therapeutic approach with monoclonal antibodies against CGRP or its receptor is moving on. Additional newly generated data for already known prophylactic agents as for new approaches are compactly discussed. Although main developments in headache focus on migraine new data on trigemino-autonomic headache trigeminal neuralgia and new daily persistant headache became available.

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