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Blutdrucksenkende Medikamente verringern Kopfschmerzen [Pharma]
11 Okt 05

1/3 weniger Kopfschmerzen bei Patienten, die blutdrucksenkende Medikamente einnehmen

Eine neue epidemiologische Studie an der Universität London hat gezeigt, dass 4 verschiedene Klassen an blutdrucksenkenden Medikamenten günstig auf Kopfschmerzen wirken. Das hat eine neue Diskussion darüber ausgelöst, ob es sich etwa bei Migräne um neurologische oder vaskuläre Kopfschmerzen handelt.

Einige Mediziner vermuten, dass Veränderungen in der Gefäßweite Migräne verursachen kann ("vaskuläre Kopfschmerzen").

Demgegenüber äußert sich der Migräne-Experte Stephen D. Silverstein:

"Until recently, medical researchers believed that tension-type headache was caused by contraction of muscles of the head and neck, and that migraine headache resulted from the expansion (or dilation) of blood vessels in the brain and scalp. The migraine aura was thought to be due to a constriction of the blood vessels, which preceded the dilation and which reduced blood supply to the eyes and brain. These theories made sense to both physicians and patients, since they accounted for the tenderness and the throbbing experienced with these forms of headache, as well as the visual disturbances of aura. However, the vascular (involving blood vessels) theory could not explain many of the other symptoms of migraine, including the mood changes before and after the attack, and the nausea and vomiting that occur during the attack.

The use of new noninvasive technology, such as MRI, PET and CT scans, along with the great advances in understanding the brain's biochemistry, have taught us much more about the causes of head pain. As we now know, vascular changes may be an important factor in a headache attack, but they are not the whole story nor the root cause. A reduction in brain activity, rather than blood supply, seems to be linked to the migraine aura. Similarly, there is little evidence that muscle contraction causes tension-type headache. Some researchers think that several stages in the complex pain-producing process are similar for these two distinct headache disorders."


Abstract:
Headaches and the Treatment of Blood Pressure
Results From a Meta-Analysis of 94 Randomized Placebo-Controlled Trials With 24 000 Participants

Malcolm Law, FRCP; Joan K. Morris, PhD; Rachel Jordan, MPH; Nicholas Wald, FRS
From the Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts, and the London Queen Mary’s School of Medicine and Dentistry, London, UK.

Correspondence to Malcolm Law, Professor of Epidemiology, London Queen Mary’s School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK. E-mail m.r.law@qmul.ac.uk

Received December 15, 2004; revision received July 25, 2005; accepted July 29, 2005.

Background— Uncertainty exists over whether blood pressure–lowering drugs prevent headache.

Methods and Results— A meta-analysis was carried out of the 94 randomized placebo-controlled trials of 4 different classes of blood pressure–lowering drugs (thiazides, ß-blockers, ACE inhibitors, and angiotensin II receptor antagonists) in fixed doses in which data on headache were reported. There were 17 641 participants who were allocated blood pressure–lowering drugs and 6603 who were allocated placebo. Treatment lowered systolic and diastolic blood pressures by 9.4 and 5.5 mm Hg, respectively, on average. One third fewer people on average reported headache in the treated groups (8.0%) than the placebo groups (12.4%) (odds ratio, 0.67; 95% CI, 0.61 to 0.74; P<0.001). About 1 in 30 treated persons benefited by having headache prevented. The prevalence of headache was reduced (P<0.001) in trials of each of the 4 classes of drugs.

Conclusions— Our results show that blood pressure–lowering drugs prevent a significant proportion of headaches. That this effect is seen with pharmacologically unrelated classes of drugs indicates that it is likely to be due to the reduction in blood pressure per se, the only recognized action that the drugs have in common. This in turn indicates that high blood pressure is a cause of headache, but this conclusion is not supported by observational studies of blood pressure and headache. The uncertainty over whether high blood pressure causes headache does not, however, detract from the practical benefits of the use of blood pressure–lowering drugs in preventing headaches and cardiovascular disease.

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