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ABSTRACT: HintergrundEs wurde die Häufigkeit von Angst und Depressionen sowie der Einfluss der Kopfschmerzschwere auf diese Erkrankungen bei den
Patienten der „Integrierten Versorgung (IV) Kopfschmerz in Bayern“ untersucht.
Material und MethodenDie deutsche Version der Hospital Anxiety and Depression Scale (HADS-D) zum Screening von Angst und Depressionen sowie den
Migraine Disability Assessment Questionnaire (MIDAS) zur Erfassung der Schwere der Kopfschmerzen bearbeiteten 181 Patienten
mit Kopfschmerzen. Neben rein deskriptiven Auswertungen wurden Korrelationskoeffizienten nach Spearman berechnet.
ErgebnisseBeim Depressions- bzw. Angstscreening erreichten 22,7 bzw. 44,7% der Patienten grenzwertige oder auffällige Ergebnisse; 19,3%
hatten grenzwertige oder auffällige Werte in beiden Bereichen. Es zeigten sich für Angst sowie Depressivität signifikante
Zusammenhänge zur Schwere der Kopfschmerzen.
SchlussfolgerungenDie Ergebnisse bestätigen die Notwendigkeit eines interdisziplinären Vorgehens bei Patienten mit Kopfschmerzen, um eine erfolgreiche
Therapie durchführen zu können. Mit dem Konzept der Integrierten Versorgung wird eine derartige Behandlung verwirklicht.
BackgroundThe prevalence of anxiety and depression and the influence of headache severity on these illnesses were examined in patients
who were part of the managed care of headache in Bavaria.
Patients and methodsA total of 181 patients with headache were screened for anxiety and depression with the German version of the Hospital Anxiety
and Depression Scale (HADS-D). Headache severity was evaluated using the Migraine Disability Assessment Questionnaire (MIDAS).
Apart from purely descriptive evaluations, Spearman’s coefficients of correlation were calculated.
ResultsOf the patients 22.7% and 44.7% obtained results at or above the limit of the normal range of depression and anxiety, respectively
and 19.3% had results at or above the limit of the normal range for both illnesses. There were significant coefficients of
correlation between the severity of headache and both anxiety and depression.
ConclusionThe results confirm the necessity for an interdisciplinary procedure in treating headache patients in order to achieve a successful
therapy. Such a treatment can be realised with the concept of managed care.
Der Schmerz 05/2012; 23(1):33-39. · 0.88 Impact Factor
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ABSTRACT: Auch im Alter sind chronisch-rezidivierende Kopfschmerzen ein häufiges Problem. So klagen bei den über 70-Jährigen etwa 10%
der Frauen und 5% der Männer über regelmäßige Kopfschmerzen. Die Inzidenz der primären Kopfschmerzen nimmt mit dem Alter ab,
die der sekundären Kopfschmerzerkrankungen eher zu. Die Symptome einer Migräne können sich im Alter ändern. So tritt die vegetative
Symptomatik eher in den Hintergrund und ein nackenbetonter, nicht mehr so stark empfundener Kopfschmerz wird häufiger angegeben.
Daneben können auch vermehrt isolierte Auren ohne nachfolgenden Kopfschmerz auftreten. Eine fast ausschließlich im höheren
Lebensalter zu beobachtende seltene primäre Kopfschmerzerkrankung ist der primär schlafgebundene Kopfschmerz, der immer aus
dem Schlaf heraus auftritt. Die im Alter relativ häufigeren sekundären Kopfschmerzformen imponieren klinisch meist als Spannungskopfschmerz.
Im Alter häufigere Ursachen für sekundäre Kopfschmerzerkrankungen sind v.a. intrakranielle Raumforderungen, Augenerkrankungen
und autoimmunologische Erkrankungen wie die Arteriitis temporalis. Eine Besonderheit älterer Patienten ist, dass häufig eine
Multimorbidität vorliegt, die zur Einnahme mehrer verschiedener Medikamente am Tag führt, sodass auch Kopfschmerzen, ausgelöst
durch eine Substanz oder deren Entzug, häufiger auftreten können. Bedingt durch diese Multimorbidität kommen Störungen der
Homöostase mit begleitenden Kopfschmerzen (Schlaf-Apnoe-Syndrom, Dialysekopfschmerz, arterielle Hypertonie, Hypothyreose)
ebenfalls häufiger vor. Bekannte Gesichtsneuralgien wie die Trigeminusneuralgie oder postherpetische Neuralgie nach einer
Herpes-zoster-Manifestation im Gesicht zeigen eine starke Häufigkeitszunahme mit dem Lebensalter. Bei der Therapie von Kopfschmerzen
im höheren Alter gilt, dass einerseits auf die Interaktion mit der bestehenden Medikation geachtet werden muss, und dass gerade
bedingt durch weitere einschränkende Erkrankungen multimodale, interdisziplinäre Therapiekonzepte zur Anwendung kommen sollten.
Chronic headache is still a frequent problem in old age, affecting about 10% of all women and 5% of all men older than 70years.
The incidence of primary headache decreases with advancing age, while that of secondary headache increases. The clinical characteristics
of migraine can also change with age; for example, vegetative symptoms are less prominent, and less intense migrainous pain
localized predominantly in the neck is frequently reported. Migraine aura can also be experienced more frequently in isolation,
without a headache. Hypnic headache is a rare primary headache syndrome that occurs almost exclusively in the elderly. Most
of the secondary headache syndromes that occur more frequently in old age present clinically as tension-type headache. Examples
of rather common reasons for secondary headache syndromes in the elderly are intracranial space-occupying lesions, ophthalmological
problems and autoimmune diseases such as giant cell arteritis. Elderly patients are especially likely to have a number of
illnesses at any one time for which they take various medications each day, so that headaches can also quite often be caused
by their medication or by withdrawal of these. As a result of such multimorbidity the homeostasis is disturbed in such patients,
leading to various conditions that can entail concomitant headaches (sleep apnoea syndrome, dialysis headache, headache attributed
to arterial hypertension or hypothyroidism). Familiar facial neuralgias, such as trigeminal neuralgia or postherpetic neuralgia
following manifest herpes zoster affecting the face, become markedly more frequent with age. In general, in the treatment
of headaches in the elderly it is essential to pay careful attention to potential interactions with the multiple drugs needed
because of other diseases; in addition, the comorbidities themselves have to be taken into account, especially depression,
anxiety and cognitive impairment, necessitating multimodal, interdisciplinary therapy plans.
Der Schmerz 04/2012; 22:22-30. · 0.88 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The prevalence of anxiety and depression and the influence of headache severity on these illnesses were examined in patients who were part of the managed care of headache in Bavaria.
A total of 181 patients with headache were screened for anxiety and depression with the German version of the Hospital Anxiety and Depression Scale (HADS-D). Headache severity was evaluated using the Migraine Disability Assessment Questionnaire (MIDAS). Apart from purely descriptive evaluations, Spearman's coefficients of correlation were calculated.
Of the patients 22.7% and 44.7% obtained results at or above the limit of the normal range of depression and anxiety, respectively and 19.3% had results at or above the limit of the normal range for both illnesses. There were significant coefficients of correlation between the severity of headache and both anxiety and depression.
The results confirm the necessity for an interdisciplinary procedure in treating headache patients in order to achieve a successful therapy. Such a treatment can be realised with the concept of managed care.
Der Schmerz 11/2008; 23(1):33-9. · 0.88 Impact Factor
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[show abstract]
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ABSTRACT: Chronic headache is still a frequent problem in old age, affecting about 10% of all women and 5% of all men older than 70 years. The incidence of primary headache decreases with advancing age, while that of secondary headache increases. The clinical characteristics of migraine can also change with age; for example, vegetative symptoms are less prominent, and less intense migrainous pain localized predominantly in the neck is frequently reported. Migraine aura can also be experienced more frequently in isolation, without a headache. Hypnic headache is a rare primary headache syndrome that occurs almost exclusively in the elderly. Most of the secondary headache syndromes that occur more frequently in old age present clinically as tension-type headache. Examples of rather common reasons for secondary headache syndromes in the elderly are intracranial space-occupying lesions, ophthalmological problems and autoimmune diseases such as giant cell arteritis. Elderly patients are especially likely to have a number of illnesses at any one time for which they take various medications each day, so that headaches can also quite often be caused by their medication or by withdrawal of these. As a result of such multimorbidity the homeostasis is disturbed in such patients, leading to various conditions that can entail concomitant headaches (sleep apnoea syndrome, dialysis headache, headache attributed to arterial hypertension or hypothyroidism). Familiar facial neuralgias, such as trigeminal neuralgia or postherpetic neuralgia following manifest herpes zoster affecting the face, become markedly more frequent with age. In general, in the treatment of headaches in the elderly it is essential to pay careful attention to potential interactions with the multiple drugs needed because of other diseases; in addition, the comorbidities themselves have to be taken into account, especially depression, anxiety and cognitive impairment, necessitating multimodal, interdisciplinary therapy plans.
Der Schmerz 03/2008; 22 Suppl 1:22-30. · 0.88 Impact Factor
