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[Headache diagnosis and vascular pathophysiology].

J Olesen1

  • 1Department of Neurology, Gentofte Hospital, University of Copenhagen.

Rinsho Shinkeigaku = Clinical Neurology
|December 1, 1990
PubMed
Summary

The new international headache classification aids uniform diagnosis. Migraine attacks involve specific regional cerebral blood flow changes, potentially linked to neurotransmitter release and headache pain.

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Area of Science:

  • Neurology and Neuroscience
  • Vascular Neurology
  • Headache Medicine

Context:

  • The International Headache Classification promotes diagnostic uniformity globally.
  • This classification is supported by the World Federation of Neurology and integrated into ICD-10.
  • Vascular mechanisms are primarily understood in migraine pathophysiology.

Purpose:

  • To detail the characterized changes in regional cerebral blood flow (rCBF) during migraine with aura attacks.
  • To explore the relationship between rCBF alterations, aura symptoms, and headache laterality.
  • To propose a mechanism involving neurotransmitter release and nociceptor sensitization in headache generation.

Summary:

  • Migraine attacks exhibit a distinct pattern of rCBF decrease, starting in the occipito-parietal region and spreading.
  • Hypoperfusion areas show abolished functional activation and diminished response to PaCO2, while autoregulation appears preserved.
  • rCBF later normalizes and becomes hyperemic in previously hypoperfused areas, with headache onset correlating to hypoperfusion.

Impact:

  • Provides a framework for understanding the neurovascular events during migraine.
  • Highlights the correlation between cerebral blood flow dynamics, aura, and headache characteristics.
  • Suggests a potential pathway for migraine headache development involving neurotransmitters and pain sensitization.

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