Blankenburg Markus, Schroth Michael, Braun Sarah
Zentrum für Kinder- und Jugendmedizin Olgahospital, Pädiatrische Neurologie, Psychosomatik und Schmerztherapie, Kinderschmerzzentrum Baden-Württemberg, Stuttgart.
Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Kinderschmerztherapie und pädiatrische Palliativmedizin.
Klin Padiatr. 2019 Jan;231(1):14-20. doi: 10.1055/a-0710-5014. Epub 2018 Oct 15.
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.
偏头痛和紧张型头痛等原发性头痛疾病早在儿童期或青少年期就开始出现。患病率在小学和青少年期有所上升。在紧张型头痛中，中枢性疼痛敏化和中枢伤害性神经元的激活起着重要作用。偏头痛是一种原发性脑部疾病，在疼痛调节系统和皮质刺激处理方面存在异常。生物心理社会因素在这两种头痛类型中都起着决定性作用。由炎症性或结构性脑部改变引起的继发性头痛很少见。诊断基于临床标准。典型的复发性头痛通过患者病史和体格检查进行诊断。如有异常，则需要进一步诊断。紧张型头痛的治疗侧重于多模式疼痛治疗，偏头痛的治疗侧重于发作期用药，继发性头痛则需要治疗潜在疾病。治疗目标是减轻疼痛感知、促进控制感和自我效能体验、提高身体机能，以及恢复正常的日常结构和社会交往，这是进一步减轻疼痛的前提条件。
