Colorflow duplex ultrasonography determines the presence and nature of vasculogenic headaches

Eighteen consecutive patients with severe headache syndromes underwent noninvasive interrogation to explore the intracranial vascular involvement in their headaches. The authors used a colorflow duplex scanner with a 2.25 MHz, tightly curved, phased-array transducer to insonate and visualize the terminal segments of the vertebral arteries; the anterior, middle, and posterior cerebral circulations; and the basilar artery. Blood flow velocities and vessel caliber were obtained during a headache-free period and during a grade 8-10 headache in all patients. Comparisons of these data indicated that 14 of the 18 patients had demonstrable arterial changes associated with their headaches. Of these 14, 4 patients were found to have marked vasospasm of at least two of the arteries in the Circle of Willis and/or the vertebrobasilar system. The remaining 10 patients had headaches associated with intracerebral vasodilation. The authors conclude that color flow duplex ultrasonography of the intracerebral arteries is capable of determining the presence and mode of vascular headache development.