Headache associated with vascular disease: migraine and stroke
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
Headache has been reported after balloon inflation or embolization of arteriovenous malformations or aneurysms.116,117 It is a severe, unilateral pain of abrupt onset that occurs shortly after the procedure and is ipsilateral to the occluded artery. It is localized to specific areas according to the artery involved: the temple for the proximal middle cerebral artery, the retroorbital area for the middle of the middle cerebral artery stem, the lateral part of the neck for the upper vertebral artery, and the vertex and occiput for the inferior portion of the basilar artery. This pain is nonthrobbing and not associated with other symptoms. It is most likely due to distention of the arterial wall and provides a good model of pure vascular headache. By contrast, pain is not mentioned in the largest series (23 patients) so far published of angioplasty for atherosclerotic intracranial stenosis.118
Pain Is a Common Problem
Harold G. Koenig in Chronic Pain, 2013
Another common form of head pain is called a migraine (or vascular headache). This headache is throbbing, occurs on one side of the head, is moderate to severe in intensity, and typically lasts from four hours to three days. Migraines are thought to result from constriction of small vessels that supply blood to the brain and the membranes that cover the brain. Vascular constriction again causes ischemia or lack of oxygenation, resulting in the release of inflammatory substances that cause excessive dilation of blood vessels. The swollen blood vessels stretch and stimulate nerves located around the blood vessels, sending pain signals to the brain. Darkness, quietness, and rest may help to ameliorate the pain. Application of cold packs, drinking caffeinated beverages, or use of drugs that constrict these dilated vessels also help to relieve symptoms. There is often a genetic or hereditary component to migraines in those so predisposed, and a variety of stimuli can set off the headache—including bright lights, certain sounds and smells, alcoholic beverages, chocolate, or intense emotional states.
Headache
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
The innervation of the large intracranial vessels and dura mater by the trigeminal nerve is known as the trigeminovascular system. The cranial parasympathetic autonomic innervation provides the basis for symptoms, such as lacrimation and nasal stuffiness, which are prominent in cluster headache and paroxysmal hemicrania, although they may also be seen in migraine. It is clear from human functional imaging studies that vascular changes in migraine and cluster headache are driven by these neural vasodilator systems so that these headaches should be regarded as neurovascular. The concept of a primary vascular headache should be consigned to the dustbin of history since it neither explains the pathogenesis of what are complex central nervous system disorders, nor does it necessarily predict treatment outcomes. The term vascular headache has no place in modern neurological practice when referring to primary headache since what is usually meant is migrainous by the adjective vascular. So it is best to refer to headache as being migrainous if indeed that is the syndrome being considered.
Role of developmental venous anomalies in etiopathogenesis of demyelinating diseases
Published in International Journal of Neuroscience, 2019
Siddika Halicioglu, Sule Aydin Turkoglu
Study Design: The study was conducted in accordance with the principles of the Helsinki Declaration and approved by the local Institutional Review Board (2016/55). Cranial MRIs of patients who were admitted to the neurology department of our tertiary center between the years 2012–2016 and diagnosed as having relapsing-remitting MS (RRMS) according to the McDonald criteria were retrospectively included into the patient group of the study (n = 105). Cranial MRI images of patients with vascular headache who presented with symptoms of headache and had no pathologic lesions in cranial MRI were evaluated as the control group. A total of 210 patients were included in the study. In the case group, MR images of patients with RRMS and RIS diagnoses with McDonald criteria followed in our clinic were included in the study. Apart from MS, other cases of immunologic disease such as malignancy, meningoencephalitis and vasculitis were excluded. Patients whose MR images were not available or centered externally excluded from the study. In the control group, cases with MR findings such as vasculitis, meningoencephalitis and malignancy were excluded.
Developments in distinguishing secondary vascular headache from primary headache disorders in clinical practice
Published in Expert Review of Neurotherapeutics, 2021
We have come a long way in the diagnosis and treatment of many vascular disorders. In the next 5 years, we envisage more research to help in the development of clear guidelines for when secondary vascular headache should be considered incorporating data of modes of presentation, risk factors and examination findings. Investigations are becoming noninvasive obviating the need for high risk procedures such as conventional angiograms. Whilst positive, this may pose disadvantages encouraging early use of modern imaging modalities over clinical judgment. This is particularly relevant in the current pandemic, whereby physicians are becoming increasingly reliant on remote consultation and investigation. The impact of the Covid 19 pandemic on the incidence and treatment of vascular headache disorders remains uncertain.
In-vitro and in-vivo respiratory deposition of a developed metered dose inhaler formulation of an anti-migraine drug
Published in Drug Delivery, 2019
Ebtsam M. Abdou, Soha M. Kandil, Amany Morsi, Maysa W. Sleem
Migraine headache is the most common neurological vascular headache disease which causes a throbbing and pulsating pain around the head due to brain and scalp arteries dilating resulting in terrible pain in the head (Green et al., 2005). Migraine treatment usually requires the drug to be accessed through the systemic circulation as the target tissue here, which is the brain, cannot be accessed through local therapy. So, rapid drug delivery to the circulation is required (Misra et al., 2003). Studies have shown that migraine patients consider rapid onset, complete and lasting pain relief, and medication side effects as the most important factors when choosing a migraine treatment (Gallagher, 2004).