Fragen

Die allgemein verbreitete Sicherheit über die trigemino-vaskuläre Pathogenese der Migräne, gestützt von unübersehbaren Fortschritten bei der Behandlung des akuten Anfalls durch Triptane, haben dazu geführt, dass eine Reihe diskreter Hinweise auf mögliche weitere pathogenetisch wirksame Mechanismen der Anfalls-Induktion weit-gehend unbeachtet blieben.



Die spontane Durchbrechung eines akuten Migräne-Anfalls durch Blockaden zervikaler oder thorakaler Grenzstrang-Ganglien [5,6] sowie die prophylaktische Wirksamkeit repetitiver Stellatum-Blockaden [11] legen die Vermutung nahe, dass Migräne-Anfälle entgegen allgemeiner Überzeugung, jedoch unter Zugrundelegung verfügbarer neuro-anatomischer und topografisch-anatomischer Daten mit Vorgängen im Bereich der Hals- oder Brustwirbelsäule [2,7,8] in Verbindung stehen könnten. Hierfür spricht auch die manual-therapeutische Beeinflussbarkeit frischer Migräne-Anfälle über die C1-Etage der Halswirbelsäule durch die Atlas-[Impuls-]Therapie nach ARLEN.

Die symptomatologische und neuroanatomische Abgrenzung des zervikogenen Kopfschmerzes von der Migräne [4,9,10] wirft in diesem Zusammenhang mehr Fragen auf, als dass die damit beabsichtigte Klarstellung klinische oder therapeutische Relevanz besäße.

Der häufig zu beobachtende Wandel von Migräne zu Spannungs-Kopfschmerz mit gleitenden Übergängen in zahllosen Varianten, die sich nach wie vor einer klaren Differenzierung nach den Kriterien der IHS-Klassifikation [3] entziehen [1], könnte als Indiz für gemeinsame Wurzeln beider Kopfschmerzformen interpretiert werden und Argumentation ihrer extrakraniellen Genese stützen.

 


Literatur

1. Barolin GS: [Headache: classification/nomenclature]. Wien Med Wochenschr. 1994;144(5-6):93-9.
As the majority of 90% chronical headaches have a multifactorial etiology, these factors have to be taken into consideration one by one. Usually more than one is to be found. Such differential diagnosis forms already a clear way into differentiated therapy. The nowadays discussed IHS-classification we see contrarely to … the demands of a good classification.

 

2. Chung K, Chung JM, LaVelle FW, Wurster RD: Sympathetic neurons in the cat spinal cord projecting to the stellate ganglion. J Comp Neurol. 1979 May 1;185(1):23-9.
A wide range (C8-T8) of spinal cord levels projected to the stellate ganglia, with a peak at the T2 level.


3. Evers S: [The new IHS classification. Background and structure]. Schmerz. 2004 Oct;18(5):351-6.
In 1988 the first IHS version appeared, and this was revised in its current version in 2003. The classification is based on the description of the headache features and thus a phenomenological rather than an etiological classification. Some patients can have more than one headache diagnosis.

 

4. Frese A, Schilgen M, Husstedt IW, Evers S: [Pathophysiology and clinical manifestation of cervicogenic headache]. Schmerz 2003 Apr;17(2):125-30.
Cervicogenic headache can origin from different muscles and ligaments of the neck, from intervertebral discs,and, particularly, from the atlantooccipital, atlantoaxial, and C2/C3 zygapophyseal joints. Diagnosis of cervicogenic headache should adhere strictly to the published diagnostic criteria to avoid misdiagnosis and confusion with primary headache disorders such as migraine and tension type headache.

 

5. Harder HJ: [Treatment of migrain blanche and ophthalmique with blocks of the superior cervical ganglion. A positive study on 84 patients]. Anaesthesist. 1981 Jan;30(1):1-9.
About 30% of all patients who were given the first treatment in an acute stage became free of complaints within a few minutes.

 

6. Higa S: [Migraine and nerve block]. Nippon Rinsho. 2001 Sep;59(9):1717-21.
C2 root ganglion block therapy is the most efficacious treatment of the acute attack of migraine. Stellate ganglion block is a usefulness of amelioration of the sensory nerves of the intracranial vessels and prevention of migraine headache.

 

7. Nozdrachev AD, Jimenez B, Morales MA, Fateev MM: Neuronal organization and cell interactions of the cat stellate ganglion. Auton Neurosci. 2002 Jan 10;95(1-2):43-56.
Sympathetic preganglionic neurons of segments C8-T10 send their axons to the stellate ganglion. The right ganglion is larger than the left and contains more cells.

 

8. Pilowsky P, Llewellyn-Smith IJ, Minson J, Chalmers J: Sympathetic preganglionic neurons in rabbit spinal cord that project to the stellate or the superior cervical ganglion. Brain Res. 1992 Apr 17;577(2):181-8.
Sympathetic preganglionic neurons that projected to the stellate ganglion were located in spinal segments T1 to T10. Sympathetic preganglionic neurons projecting to the superior cervical ganglion were found in segments T1 to T8. Almost 95% of the neurons supplying the superior cervical ganglion had axons that passed through the stellate ganglion.

 

9. Pollmann W, Keidel M, Pfaffenrath V: Headache and the cervical spine: a critical review. Cephalalgia. 1997 Dec;17(8):801-16.
Primary headaches such as tension-type headache and migraine are incorrectly categorized as „cervicogenic“ merely because of their occipital localization. Ipsilateral blockades of the C2 root and/or greater occipital nerve allow a differentiation between cervicogenic headache and primary headache syndromes such as migraine or tension-type headache.

 

10. Sjaastad O, Bovim G: Cervicogenic headache. The differentiation from common migraine. An overview. Funct Neurol. 1991 Apr-Jun;6(2):93-100.
Typical migraine symptoms, such as nausea, vomiting, photophobia, and phonophobia also occur in cervicogenic headache, but less frequently and to a lesser degree. In our estimation, cervicogenic headache and common migraine are two distinct disorders, with their own clinical patterns, pathogenesis, treatment - and, in all probability, also prognosis.

 

11. Ullrich J: [Stellate ganglion block under EEG control in the treatment of complicated cervical migraine]. Neurol. 1975 Aug 1;209(4):301-6.
A transient amelioration of the pathological EEG pattern was observed after each stellate ganglion block and after several treatments the EEG was normal and the migraine attacks disappeared.




Wissenschaft  Fragen  web

 

 

 

0 72 21 - 2 44 66

Genießen
statt Leiden

Investieren
statt nur ausgeben
Impressum