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Das Fenster zur Kopfschmerzforschung

Was lehrt uns die funktionelle und strukturelle Neurobildgebung?

The window into headache research

What have we learned from functional and structural neuroimaging?

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Zusammenfassung

Aktuelle Ergebnisse der funktionellen Bildgebung des Gehirns bei Patienten mit Kopfschmerzen zeigen, dass vaskuläre Veränderungen nicht die primäre Ursache für den Schmerz in der Migräne sind. Die funktionelle Bildgebung hat gerade in der Kopfschmerzforschung erstmals das Gebiet einer rein anatomisch zuordnenden Wissenschaft verlassen und grundlegende Hinweise zur Pathophysiologie idiopathischer Syndrome geliefert. Die aktuellen Befunde der Neurobildgebung bei den verschiedensten Kopfschmerzerkrankungen zeigen eindeutig, dass die Migräne mit einer primären Dysfunktion des endogenen antinozizeptiven Systems einhergeht, zu denen das periaquäduktale Grau (PAG) und der Nucleus dorsalis raphe (DRN) des Mittelhirns sowie die Hirnstammstrukturen zählen, die die neuronale Kontrolle des zerebralen Blutflusses steuern (DRN und Locus coeruleus). In die fundamentalen Prozesse der akuten Cluster-Kopfschmerzattacken ist hingegen der Hypothalamus involviert. Diese Daten konnten von verschiedenen Arbeitsgruppen mehrfach repliziert werden und läuteten überzeugend eine neue Ära der pathophysiologischen Vorstellung dieser Syndrome und explizit die Bedeutung des Gehirns für diese Erkrankungen ein. Die jüngsten Arbeiten zu strukturellen Veränderungen des Gehirns bei Migräne, beim Spannungskopfschmerz und beim Cluster-Kopfschmerz sind in ihrer Bedeutung noch nicht abschätzbar, werfen aber fundamentale Fragen auf und lassen erwartungsvoll in die Zukunft unseres Verständnisses eines der häufigsten Symptome des Menschen blicken.

Abstract

Current functional neuroimaging studies in headache patients have demonstrated that changes in vascular function are not the primary cause for the pain in migraine. Especially in headache research, functional imaging revealed for the first time important information on the pathophysiology of idiopathic syndromes beyond mere anatomical attribution. Several independent studies have reinforced the crucial role of the brainstem in migraine resulting in primary dysfunction of the endogenous antinociceptive systems, including the periaqueductal grey and the dorsal raphe nucleus (DRN) in the midbrain as well as areas involved in the neuronal regulation of cerebral blood flow (DRN and locus coeruleus). The hypothalamus on the other hand is involved in the fundamental processes leading to the acute attacks of cluster headache. These data have been repeatedly replicated by several groups and led to a new understanding of the pathophysiology of these syndromes and specifically the central role of the brain. The recent studies investigating the structural changes in migraine, chronic tension-type headache and cluster headache are not yet clear in their relevance but raise important questions and promise increasing knowledge of one of the most frequent symptoms in humans.

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Danksagung

Der Autor dankt Anne Stankewitz für das Korrekturlesen. A. May wird von der Deutschen Forschungsgemeinschaft (MA 1862/2) gefördert. Diese Arbeit wird durch das Bundesministerium für Bildung und Forschung (Projekt No. 371 57 01) unterstützt.

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Diese Arbeit wurde möglich durch die Unterstützung der DFG und des BMBF.

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  1. Institut für systemische Neurowissenschaften, Universitäts-Krankenhaus Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland

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May, A. Das Fenster zur Kopfschmerzforschung. Schmerz 24, 130–136 (2010). https://doi.org/10.1007/s00482-010-0898-y

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