Botulinumtoxin beim Kopfschmerz vom Spannungstyp

Zusammenfassung

Botulinumtoxin (BTX) ist mittlerweile für einige Indikationen zugelassen. Daneben hat es eine weite Verbreitung bei etlichen anderen Indikationen gefunden, wobei hier der Schmerz besonders hervorgehoben werden sollte. Die häufigste Kopfschmerzform ist der Kopfschmerz vom Spannungstyp (KST), dessen Pathogenese ungeklärt ist. Ein Zusammenspiel von vaskulären, myofaszialen und supraspinalen Einflüssen ist wahrscheinlich. Angenommen wird, dass myofasziale Stimuli den Kopfschmerz triggern können. Die medikamentösen und sonstigen therapeutischen Erfolge bei der chronischen Verlaufsform sind begrenzt, der Einsatz von BTX eine sinnvolle Alternative. Der Einsatz ist zu erwägen, wenn die perikranielle Muskulatur beteiligt ist. Ein Effekt wird unter anderem dadurch erzielt, dass der muskuläre Stress, die muskuläre Ischämie und der Muskeltonus reduziert werden. Ob weitere Mechanismen wie retrograder Transport und direkte antiinflammatorische Potenz eine Rolle spielen, ist noch ungeklärt. Nach bisheriger Datenlage werden Häufigkeit und Ausprägung der Kopfschmerzen reduziert. Relevante unerwünschte Wirkungen sind nicht zu erwarten. Die ideale Dosis sowie die optimale Auswahl der Injektionsorte sind noch nicht geklärt, wobei ein individuelles Injektionsschema sinnvoll erscheint. Die Injektion in Triggerpunkte empfiehlt sich.

Abstract

Botulinum toxin has meanwhile been approved for a number of indications. It is also gaining acceptance in other indications with a major focus on pain. The most common type of headache is tension-type headache (TTH) the pathogenesis of which has not yet been unfolded. As it looks there are vascular, myofascial and supraspinal factors intertwined. It is felt that headache is triggered by myofascial stimuli. The application of botulinum toxin is an intelligent alternative since the favorable effect of pharmacologic and other therapies is limited. Application of BTX should be considered when the pericranial muscles are involved. One of the effects produced lies in the reduction of muscular stress, muscular ischemia and muscle tone. We still don't know whether additional mechanisms such as retrograde uptake and direct antiinflammatory potential are involved. Current data permit the conclusion that headaches are decreased in their frequency and distinctiveness. Significant untoward effects are not to be expected. Neither the ideal dose nor the optimum selection of injection sites have been established as yet, an individual injection scheme is apparently most promising. Injection of the trigger points seems to make sense.

Literatur

• 1 Headache Classification Committee of the International Headache Society . Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain.  Cephalalgia. 1988;  8 (Suppl. 7) 1-96
• 2 Rozen T D, Swanson J W, Stang P E, McDonnell S K, Rocca W A. Increasing incidence of medically recognized migraine headache in a United States population.  Neurology. 1999;  53 1468-1473
• 3 Lipton R B, Goadsby P, Silberstein S D. Classification and epidemiology of headache.  Clin Cornerstone. 1999;  1 1-10
• 4 Göbel H, Petersen-Braun M, Soyka D. The epidemiology of headache in Germany: a nationwide survey of a representative sample on the basis of the headache classification of the International Headache Society.  Cephalalgia. 1994;  14 97-106
• 5 Schwartz B S, Stewart W F, Simon D, Lipton R B. Epidemiology of tension-type headache.  JAMA. 1998;  279 381-383
• 6 Rasmussen B K, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population - a prevalence study.  J Clin Epidemiol. 1991;  44 1147-1157
• 7 Launer L J, Terwindt G M, Ferrari M D. The prevalence and characteristics of migraine in a population-based cohort: the GEM study.  Neurology. 1999;  53 537-542
• 8 Oestergaard S, Russell M B, Bendtsen L, Olesen J. Increased familial risk of chronic tension-type headache.  Br Med J. 1997;  314 1092-1093
• 9 Russel M B, Ostergaard S, Bendtsen L, Olesen J. Familial occurrence of chronic tension-type headache.  Cephalalgia. 1999;  19 207-210
• 10 Bendtsen L, Jensen R, Hindberg I, Gammeltoft S, Olesen J. Serotonin metabolism in chronic tension-type headache.  Cephalalgia. 1997;  17 843-848
• 11 Shimomura T, Awaki E, Kowa H, Takahashi K. Treatment of tension-type headache with tizanidine hydrochloride: its efficacy and relationship to the plasma MHPG concentration.  Headache. 1991;  31 601-604
• 12 Castillo J, Martinez F, Leira R, Lema M, Noya M. Plasma monoamines in tension-type headache.  Headache. 1994;  34 531-535
• 13 Mazzotta G, Sarchielli P, Gaggioli A, Gallai V. Study of pressure pain and cellular concentrations of neurotransmitters related to nociception in episodic tension-type headache patients.  Headache. 1997;  37 565-571
• 14 Pfaffenrath V, Brune K, Diener H C, Gerber W D, Göbel H. Die Behandlung des Kopfschmerzes vom Spannungstyp. Therapieempfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft.  Nervenheilkunde. 1998;  17 91-100
• 15 Heckmann J G, Mück-Weymann M, Katalinic A, Hilz M J, Claus D, Neundörfer B. TCD-Ergometer-Test bei Patienten mit chronischem Kopfschmerz vom Spannungstyp.  Nervenarzt. 1998;  69 131-136
• 16 Hannerz J, Jogestrand T. Is chronic tension-type headache a vascular headache? The relation between chronic tension-type headache and cranial hemodynamics.  Headache. 1998;  38 668-675
• 17 Jensen R. Pathophysiological mechanisms of tension-type headache: a review of epidemiological and experimental studies.  Cephalalgia. 1999;  19 602-621
• 18 Göbel H. Die Kopfschmerzen. Heidelberg: Springer-Verlag 1997
• 19 Clark G T, Sakai S, Merrill R, Flack V F, McCreary C. Cross-correlation between stress, pain, physical activity, and temporalis muscle EMG in tension-type headache.  Cephalalgia. 1995;  15 511-518
• 20 Ashina M, Bendtsen L, Jensen R, Sakai F, Olesen J. Muscle hardness in patients with chronic tension-type headache: relation to actual headache state.  Pain. 1999;  79 201-205
• 21 Jensen R, Rasmussen B K. Muscular disorders in tension-type headache.  Cephalalgia. 1996;  16 97-103
• 22 Langemark M, Jensen K, Olesen J. Temporomuscle blood flow in chronic tension-type headache.  Arch Neurol. 1990;  47 654-658
• 23 Jensen R, Bendtsen L, Olesen J. Muscular factors are of importance in tension-type headache.  Headache. 1998;  38 10-17
• 24 Wheeler A H. Botulinum toxin A, adjunctive therapy for refractory headaches associated with pericranial muscle tension.  Headache. 1998;  38 468-471
• 25 Jensen R, Olesen J. Initiating mechanisms of experimentally induced tension-type headache.  Cephalalgia. 1996;  16 175-182
• 26 Langemark M, Bach F W, Jensen T S, Olesen J. Decreased nociceptive flexion reflex threshold in chronic tension-type headache.  Arch Neurol. 1993;  50 1061-1064
• 27 Goadsby P J. Chronic tension-type headache: where are we?.  Brain. 1999;  122 1611-1612
• 28 Sheftell F D. Chronic daily headache.  Neurology. 1992;  42 (suppl. 2) 32-36
• 29 Wöber-Bingöl C, Wöber C, Zeiler K, Heimberger K, Baumgartner C, Samec P, Wessely P. Tension headache and the cervical spine - plain X-ray findings.  Cephalalgia. 1992;  12 152-154
• 30 Göbel H, Hamouz V, Hansen C, Heininger K, Hirsch S, Lindner V, Heuss D, Soyka D. Chronic tension-type headache: amitriptyline reduces clinical headache-duration and experimental pain sensitivity but does not alter pericranial muscle activity readings.  Pain. 1994;  59 241-249
• 31 Pfaffenrath V, Diener H C, Isler H, Meyer C, Scholz E, Taneri Z, Wessely P, Zaiser-Kaschel H, Haase W, Fischer W. Efficacy and tolerability of amitriptylinoxide in the treatment of chronic tension-type headache: a multi-center controlled study.  Cephalalgia. 1994;  14 149-155
• 32 Binder W J, Brin M F, Blitzer A, Schoenrock L D, Pogoda J M. Botulinum toxin type A (Botox) for the treatment of migraine headaches: An open label study.  Otolaryngol Head Neck Surg. 2000;  123 669-676
• 33 Carruthers A, Langtry J A, Carruthers J, Robinson G. Improvement of tension-type headache when treating wrinkles with botulinum toxin A injections.  Headache. 1999;  39 662-665
• 34 Freund B J, Schwartz M. Treatment of chronic cervical-associated headache with botulinum toxin type A: a pilot study.  Headache. 2000;  40 231-236
• 35 Freund B J, Schwartz M. A focal dystonia model for subsets of chronic tension headache.  Cephalalgia. 2000;  20 433
• 36 Göbel H, Lindner V, Krack P, Heinze A, Gaartz N, Deuschl G. Treatment of chronic tension-type headache with botulinum toxin.  Cephalalgia. 1999;  19 455
• 37 Klapper J A, Mathew N T, Klapper A, Kailasam J. Botulinum toxin type a (BTX-A) for the prophylaxis of chronic daily headache.  Cephalalgia. 2000;  20 292-293
• 38 Krack P, Hornig C, Dorndorf W. Resolution of chronic tension headache after botulinum toxin treatment of idiopathic blepharospasm.  Mov Disord. 1995;  10 388
• 39 Porta M. A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of tension-type headache.  Curr Rev Pain. 2000;  4 31-35
• 40 Relja M. Treatment of tension-type headache by local injection of botulinum toxin.  Eur J Neurology. 1997;  4 Suppl 2 S71-73
• 41 Relja M, Korsic M. Treatment of tension type headache by injections of botulinum toxin type A: double-blind placebo-controlled study.  Neurology. 1999;  52 A203
• 42 Relja M A. Treatment of tension-type headache with botulinum toxin: 1-year follow-up.  Cephalalgia. 2000;  20 336
• 43 Relja M A, Klepac N. Botulinum toxin type A as a prophylactic treatment in chronic tension-type headache: long-term follow-up study.  Neurology.. 2001;  56 (suppl 3) A349-A350
• 44 Rollnik J D, Tanneberger O, Schubert M, Schneider U, Dengler R. Treatment of tension-type headache with botulinum toxin type A: a double-blind, placebo-controlled study.  Headache. 2000;  40 300-305
• 45 Schmitt W J, Slowey E, Fravi N, Weber S, Burgunder J M. Effect of botulinum toxin A injections in the treatment of chronic tension-type headache: a double-blind, placebo-controlled trial.  Headache. 2001;  41 658-664
• 46 Schulte-Mattler W J, Wieser T, Zierz S. Treatment of tension-type headache with botulinum toxin: a pilot study.  Eur J Med Res. 1999;  4 183-186
• 47 Smuts J A, Baker M K, Smuts H M, Rheta S tassen, Rossouw E, Barnard P WA. Prophylactic treatment of chronic tension-type headache using botulinum toxin type A.  Eur J Neurol.. 1999;  6 (suppl 4) S99-S102
• 48 Smuts J A, Baker M K, Smuts H M, Stassen J MM, Rossouw E, Barnard P WA. Botulinum toxin type A as prophylactic treatment in chronic tension-type headache.  Cephalalgia. 1999;  19 454
• 49 Smuts J A, Barnard P WA. Botulinum toxin type A in the treatment of headache syndromes: a clinical report of 79 patients.  Cephalalgia. 2000;  20 332
• 50 Zwart J A, Bovim G, Sand T, Sjaastad O. Tension headache: botulinum toxin paralysis of temporal muscles.  Headache. 1994;  34 458-462
• 51 Blumenefeld A. Botulinum toxin type A (Botox) as an effective prophylactic treatment in headache.  Cephalalgia. 2002;  22 20
• 52 Lin J J, Chang D C. Efficient treatment of chronic tension-type headache with botulinum toxin-A.  Cephalalgia. 2002;  22 15
• 53 Lopez-Lozano J J, Mata M, Dorado R, Tuduri L. Clinical study of the value of botulinum toxin-A (Botox) in the treatment of chronic tension-type headache with associated pericranial muscle tenderness.  Cephalalgia. 2002;  22 32
• 54 Padberg M, de Bruijn S FTM, Tavy D LJ. Treatment of chronic tension-type headache with botulinum-toxin: a double blind, placebo controlled trial.  Cephalalgia. 2002;  22 10
• 55 Rasmussen B K, Jensen R, Olesen J. Impact of headache on sickness absence and utilisation of medical services: a Danish population study.  J Epidemiol Community Health. 1992;  46 443-446
• 56 Blumenfeld A. Decrease in headache medication use and cost after botulinum toxin type A (Botox) treatment in a high triptan use population. Presented at the AHS, Istanbul, June 21 - 23 2002