Vascular headache

Introduction Vascular headache refers to the clinical syndrome caused by vasomotor dysfunction of the head and dysfunction of the cerebral cortex, or temporary changes in certain body fluids. It is characterized by paroxysmal pulsating jump, pain or drilling in one or both sides of the ankle. It may be accompanied by symptoms of vascular autonomic dysfunction such as visual hallucinations, photophobia, hemianopia, nausea and vomiting. It includes headaches caused by migraine, cluster headache, hypertensive headache, cerebrovascular disease (such as subarachnoid hemorrhage, cerebral hemorrhage, arteriovenous malformation, temporal arteritis, etc.).

Cause

Causes of vascular headache

Primary vascular headache, also known as migraine, is a functional headache. According to the different manifestations of headache, it can be divided into five main types: typical migraine, common migraine, cluster migraine, hemiplegic migraine and ophthalmoplegia migraine.

The vascular headache that everyone usually refers to is migraine. As for which type, it depends on its clinical manifestations, but common type migraine is the most common among outpatients.

an examination

Related inspection

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Vascular headache examination

1. EEG examination: It is generally believed that the abnormal incidence of EEG in patients with migraine is higher than that in the normal control group, whether in the attack or intermittent period. However, the EEG changes in migraine patients are not specific. Because it can have a normal waveform. Common slow waves, spike discharges, focal spikes, waves, and various waveforms that respond abnormally to hyperventilation and flash stimulation. The abnormal rate of electroencephalogram in children with migraine is high, ranging from 9% to 70%. There may be spikes, paroxysmal slow waves, fast wave activity and diffuse slow waves.

2. Cerebral blood flow examination: The main changes in the cerebral blood flow map of the patient during the attack period and the intermittent period are asymmetric amplitude on both sides, one side is high or one side is low.

3. Cerebral angiography: In principle, patients with migraine do not need cerebral angiography. Only in patients with severe headache episodes, patients with high degree of suspected subarachnoid hemorrhage undergo cerebral angiography, except for intracranial aneurysms. , arteriovenous malformations and other diseases. Undoubtedly, the majority of cerebral angiograms in migraine patients are normal.

4. Cerebrospinal fluid examination: routine examination of cerebrospinal fluid in patients with migraine is usually normal, and lymphocytes in cerebrospinal fluid can be increased in general.

5. Immunological examination: Immunoglobulin IgG and IgA in migraine patients are generally considered to be higher than normal.

6. Platelet function test: platelet aggregation in patients with migraine can be increased.

Differential diagnosis

Vascular headache confusing symptoms

Vascular headache

Broadly speaking, vascular headaches should include two parts:

1. Headache caused by head vasomotor dysfunction is migraine. These include typical migraine, common migraine, cluster headache, hemiplegia or ocular paralysis migraine.

2, headache caused by cerebrovascular diseases, including acute ischemic cerebrovascular disease, subarachnoid hemorrhage, arteriovenous malformation, hypertension, intracranial hematoma, intracranial venous thrombosis, internal carotid artery and vertebral artery disease The headache caused.

However, in terms of clinical practice and etiology classification, it is divided into functional headache and organic headache in principle. Therefore, a headache caused by head vasomotor dysfunction, that is, a migraine class, is included in the former (functional headache). The headache caused by cerebrovascular disease is included in the latter (organic headache). include:

1 acute ischemic cerebrovascular disease: transient ischemic attack; thromboembolic cerebrovascular disease.

2 intracranial hematoma: subdural hematoma; epidural hematoma.

3 subarachnoid hemorrhage.

4 unruptured vascular malformations: arteriovenous malformations; intracapsular aneurysms.

5 arteritis: giant cell arteritis; other systemic vasculitis; primary intracranial arteritis.

6 carotid or vertebral artery pain: carotid or vertebral artery block; (primary) carotid pain; headache after arterial incision.

7 venous thrombosis.

8 arterial hypertension: acute reaction to exogenous substances; pheochromocytoma; malignant hypertension; pre-eclampsia and eclampsia.

9 headaches associated with other vascular disorders.

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