Schmerztherapie

ZusammenfassungIn diesem Artikel wird eine aktuelle Übersicht über die Prinzipien der modernen Schmerztherapie gegeben. Folgende Neuerungen der letzten Jahre sind von besonderer Bedeutung. Bei der Therapie chronischer Schmerzen erzielt die Kombination medikamentöser und nicht medikamentöser Maßnahmen die besten Erfolge. Der Einsatz von Opioiden kann unter Beachtung der evidenzbasierten Leitlinien auch bei Nichttumorschmerzen erfolgen. Die neuen Opioide sind nebenwirkungsärmer geworden, insbesondere im gastrointestinalen Bereich. Neuerdings steht ein spezifisches Naltrexon-Analogon zur Behandlung der opioidinduzierten Obstipation zur Verfügung. Neue Substanzen gegen neuropathische Schmerzen sind Oxcarbazepin, Pregabalin, Duloxetin und Lacosamid. Akupunktur bei chronischen Schmerzen ist besser als Warteliste. Für die Diagnostik von Kopfschmerzen ist 2004 eine neue Klassifikation der International Headache Society erschienen. Vor allem das Konzept des Chronic Daily Headache ist dabei weiterentwickelt worden. In der Attackenbehandlung der Migräne erzielt der frühzeitige Einsatz von Triptanen den besten Therapieerfolg. Eine Kombination von Triptanen und NSAR ist in Einzelfällen insbesondere beim Wiederkehrkopfschmerz sinnvoll. Substanzen der ersten Wahl in der Migräneprophylaxe sind die Betablocker Propranolol und Metoprolol, Flunarizin, Valproat und Topiramat.

Download Full-text

Evaluation of Chronic Daily Headache—Comparison to Criteria for Chronic Tension-Type Headache

Cephalalgia ◽

10.1111/j.1468-2982.1992.00365.x ◽

1992 ◽

Vol 12 (6) ◽

pp. 365-368 ◽

Cited By ~ 59

Author(s):

Seymour Solomon ◽

Richard B Lipton ◽

Lawrence C Newman

Keyword(s):

Chronic Daily Headache ◽

Medication Overuse ◽

International Headache Society ◽

Tension Type Headache ◽

Chronic Tension Type Headache ◽

Ihs Classification ◽

Analgesic Medication ◽

Daily Headache ◽

Ihs Criteria ◽

Type Headache

The purpose of this study was to evaluate the adequacy of the International Headache Society (IHS) criteria for chronic tension-type headache and, if appropriate, suggest modifications of the IHS classification. We evaluated 100 consecutive patients with chronic daily headache. Approximately two-thirds of our patients fulfilled the criteria for chronic tension-type headache. Most of the patients who failed to meet the criteria did so because they had more than one migrainous feature. Approximately 50% of patients took excessive amounts of analgesic medication. We conclude that the IHS criteria should be modified to include chronic daily headache evolving from migraine; subtypes with and without medication overuse should be distinguished.

Download Full-text

Classification of Chronic Daily Headache by International Headache Society Criteria: Limits and New Proposals

Cephalalgia ◽

10.1046/j.1468-2982.1995.1501037.x ◽

1995 ◽

Vol 15 (1) ◽

pp. 37-43 ◽

Cited By ~ 75

Author(s):

GC Manzoni ◽

F Granella ◽

G Sandrini ◽

A Cavallini ◽

C Zanferrari ◽

...

Keyword(s):

Retrospective Study ◽

Chronic Daily Headache ◽

International Headache Society ◽

Tension Type Headache ◽

Clear Cut ◽

Ihs Classification ◽

Daily Headache ◽

Type Headache ◽

Headache Centres

We conducted a retrospective study of 150 patients with chronic daily headache (CDH) to determine how to categorize their headache according to the classification of the International Headache Society (IHS). All patients were first evaluated at Parma and Pavia Headache Centres (from January 1992 to March 1993) and had had headache for at least 15 days a month during the previous 6 months. Four patients were thereafter excluded due to poor reliability. The 146 patients who met our CDH criteria (92 with and 54 without clear-cut migraine attacks) could be classified into four groups: (i) chronic tension-type headache (CTTH)-27 patients; (ii) coexisting migraine plus CTTH-65 patients; (iii) unclassifiable daily headache-27 patients; and (iv) migraine and an unclassifiable interval headache-27 patients. Seventy-two percent of patients with CDH had migraine as the initial form of their headache. We therefore propose to revise the IHS classification for migraine, taking into account its evolution, and add two subcategories, migraine with interparoxysmal headache and chronic migraine.

Download Full-text

The International Headache Society Classification of Chronic Daily and Near-Daily Headaches

Cephalalgia ◽

10.1046/j.1468-2982.1996.1606407.x ◽

1996 ◽

Vol 16 (6) ◽

pp. 407-411 ◽

Cited By ~ 36

Author(s):

J Olesen ◽

BK Rasmussen

Keyword(s):

Chronic Daily Headache ◽

International Headache Society ◽

Sudden Onset ◽

Hemicrania Continua ◽

Transformed Migraine ◽

Ihs Classification ◽

Daily Headache ◽

Future Revision ◽

International Headache Society Classification

The classification of the International Headache Society (IHS) published in 1988 has been positively received throughout the world. However, the classification of headaches occurring daily or almost daily has been criticized repeatedly. This criticism is discussed in the present review. It is possible to classify virtually all chronic headache patients using the IHS Classification and there seems to be more need for emphasizing a correct application of the classification than for a revision in this regard. The entity of transformed migraine is disputed and so is the existence of hemicrania continua. Neither of these syndromes has been adequately defined nor studied. Chronic daily headache of sudden onset (new persistent daily headache) is not adequately classified at present and should be included as a separate entity in the next edition of the IHS Classification. In a future revision it should also be possible to classify drug-related headache simply on the basis of drug consumption and without mandatory demands for withdrawal. Better longitudinal studies of patients with chronic daily headache are necessary to evaluate finally whether a revision of the classification of these headache syndromes is necessary. Eventually the ongoing discovery of migraine genes is likely to change radically the classification of migraine.ÿ

Download Full-text

The Global Burden of Headache: A Documentation of Headache Prevalence and Disability Worldwide

Cephalalgia ◽

10.1111/j.1468-2982.2007.01288.x ◽

2007 ◽

Vol 27 (3) ◽

pp. 193-210 ◽

Cited By ~ 1280

Author(s):

LJ Stovner ◽

K Hagen ◽

R Jensen ◽

Z Katsarava ◽

RB Lipton ◽

...

Keyword(s):

Chronic Daily Headache ◽

International Headache Society ◽

Adult Population ◽

Tension Type Headache ◽

World Health ◽

Headache Disorders ◽

Burden Of Headache ◽

The World ◽

Daily Headache ◽

Type Headache

This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.

Download Full-text

Chronic daily headache and the revised international headache society classification

Current Pain and Headache Reports ◽

10.1007/s11916-004-0041-9 ◽

2004 ◽

Vol 8 (1) ◽

pp. 59-65 ◽

Cited By ~ 11

Author(s):

Morris Levin

Keyword(s):

Chronic Daily Headache ◽

International Headache Society ◽

Daily Headache ◽

International Headache Society Classification

Download Full-text

Chronic Daily Headache in A Tertiary Care Population: Correlation Between the International Headache Society Diagnostic Criteria and Proposed Revisions of Criteria for Chronic Daily Headache

Cephalalgia ◽

10.1046/j.1468-2982.2002.00384.x ◽

2002 ◽

Vol 22 (6) ◽

pp. 432-438 ◽

Cited By ~ 70

Author(s):

ME Bigal ◽

FD Sheftell ◽

AM Rapoport ◽

RB Lipton ◽

SJ Tepper

Keyword(s):

Chronic Migraine ◽

Chronic Daily Headache ◽

International Headache Society ◽

Tertiary Care ◽

Tension Type Headache ◽

Classification Systems ◽

Common Diagnosis ◽

Ihs Classification ◽

Daily Headache

The International Headache Society (IHS) has been criticized for its approach to classification of chronic daily headache (CDH); Silberstein and Lipton criteria provide an alternative to this approach. The aim of this study is to apply the alternative diagnostic approaches to a sample of CDH patients consulting in specialty care. Our sample consisted of 638 patients with CDH. Patients were classified according to both classification systems. Patients were predominantly female (65.0%), with ages ranging from 11 to 88 years. According to the Silberstein and Lipton classification, we found eight different diagnoses. The most common diagnosis was chronic migraine (87.4%), followed by new daily persistent headache (10.8%). Just six patients had chronic tension- type headache (CTTH). Applying the IHS criteria we found 14 different diagnoses. Migraine was found in 576 (90.2%) patients. CTTH occurred in 621 (97.3%), with only 10 (1.57%) having this as the sole diagnosis. We conclude that both systems allow for the classification of most patients with CDH when daily headache diaries are available. The main difference is that the IHS classification is cumbersome and requires multiple diagnoses. The Silberstein and Lipton system is easier to apply, and more parsimonious. These findings support revision of the IHS classification system to include chronic migraine.

Download Full-text

Chronic Daily Headache in Childhood and Adolescence: Clinical Aspects and a 4-Year Follow-up

Cephalalgia ◽

10.1111/j.1468-2982.2004.00758.x ◽

2004 ◽

Vol 24 (10) ◽

pp. 850-858 ◽

Cited By ~ 56

Author(s):

F Galli ◽

L Patron ◽

PM Russo ◽

O Bruni ◽

LF Strambi ◽

...

Keyword(s):

Psychiatric Disorders ◽

Chronic Daily Headache ◽

International System ◽

International Headache Society ◽

Diagnostic System ◽

Clinical Aspects ◽

Childhood And Adolescence ◽

Age Related ◽

Co Morbidity ◽

Daily Headache

Chronic daily headache (CDH) represents a challenge in clinical practice and the scientific field. CDH with onset in children and adolescents represent a matchless opportunity to understand mechanisms involved in adult CDH. The aim of this study was to evaluate the diagnosis, prognosis and psychiatric co-morbidity of CDH with young onset in the young. Fifty-nine CDH patients has been followed from 1997 to 2001 in our department. Headache and psychiatric diagnoses were made on the basis of the international system of classification (International Headache Society, 1988; DSM-IV). X2 test and multinomial logistic regressions were applied to analyse factors predicting outcome. The current diagnostic system allows a diagnosis in 80% of CDH patients, even if age-related characteristics have been evidenced. Psychiatric disorders are notable in CDH (about 64% of patients) and predict (mainly anxiety) a poorer outcome. Surprisingly, analgesic overuse is not involved in the chronicization process. Diagnosis of CDH needs further study. Psychiatric disorders predict a worse outcome and greater account should be taken of them in treatment planning.

Download Full-text