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Fortschr Neurol Psychiatr 2003; 71(6): 296-305
DOI: 10.1055/s-2003-39592
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Botulinumtoxin beim Kopfschmerz vom Spannungstyp

Botulinum Toxin in Tension-Type HeadacheW.  H.  Jost1
  • 1Fachbereich Neurologie der Deutschen Klinik für Diagnostik, Wiesbaden
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Publication History

Publication Date:
10 June 2003 (online)

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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.

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Prof. Dr. W. Jost

FB Neurologie & Klin. Neurophysiologie/Schmerztherapie · Deutsche Klinik für Diagnostik

Aukammallee 33

65191 Wiesbaden

Email: jost.neuro@dkd-wiesbaden.de