Kopfschmerzen bei Kindern: Auch ein kinder- und jugendpsychiatrisches Problem?
Pathogenese, Komorbidität, Therapie
Abstract
Zusammenfassung: Kopfschmerzen gehören zu den häufigsten rezidivierenden Körperbeschwerden im Schulalter und lassen sich meist als Migräne oder Spannungskopfschmerzen klassifizieren. Die Prävalenz im Kindes- und Jugendalter steigt bei sinkendem Erstmanifestationsalter. Die Diagnose erfolgt nach den Kriterien der Internationalen Kopfschmerzgesellschaft. Sie gründet sich v.a. auf subjektive Aussagen von Patienten und Eltern und sollte auf einer gründlichen Anamnese (inkl. Familien- und Sozialanamnese), einem Kopfschmerztagebuch und einem internistisch-neurologischen Status beruhen. Eine weiterführende apparative Diagnostik (EEG, CT, MRT) ist nur bei gezieltem Verdacht auf symptomatische Kopfschmerzen bzw. andere Diagnosen erforderlich. Verschiedene ätiopathogenetische Modelle mit Implikationen für das therapeutische Vorgehen werden diskutiert. Nicht nur für die Akuttherapie, sondern auch für die Prophylaxe kindlicher Kopfschmerzen stehen heute verschiedene gut verträgliche medikamentöse und nichtmedikamentöse Optionen (Entspannungsverfahren, Biofeedback, psychologische Therapie usw.) zur Verfügung, die bisher jedoch zu selten eingesetzt werden. Auch eine fundierte Beratung von Eltern und Kind führt häufig zu einer Besserung. In mehr als 50% chronifizieren kindliche Kopfschmerzen ins Erwachsenenalter hinein, was durch häufig vorhandene psychiatrische Komorbidität wesentlich begünstigt wird. Angststörungen und Depressionen treten gehäuft auf, außerdem Somatisierung und Schulstörungen. Es ist unbedingt zu empfehlen, bei Kindern und Jugendlichen mit chronischen Kopfschmerzen nach einer eventuell bestehenden psychiatrischen Komorbidität zu suchen und diese gegebenenfalls zu behandeln.
Summary: Headache is a recurrent somatic complaint in childhood and adolescence. In recent decades headache prevalence has increased while the age of onset has decreased. In most cases headache can be categorized as migraine or tension-type headache without significant organic pathology, i.e. head trauma, structural lesion, etc. Diagnosis according to the criteria of the International Headache Society is based on subjective reports by patients and their parents. The basic tools of clinical assessment are history, physical examination and a headache diary. Laboratory tests, including electroencephalography and imaging studies should not, as a rule, be undertaken routinely. Pathophysiological models with an impact on therapeutic interventions will be discussed. Childhood headache is often treated inappropriately in daily practice despite the availability of various options (including environmental, drug, and psychological therapy). Psychological therapy (relaxation training, biofeedback, stress management, etc.) as well as medication can be applied for prophylaxis. Minimal therapeutic interventions have been shown to be equally effective in a remarkable number of patients. Chronic Headache shows relevant comorbidity with anxiety and depression and is associated with somatization and school disorders. A careful investigation and an adequate therapy of eventual psychiatric comorbidity is therefore strongly recommended.
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