Headache in transient ischaemic attacks

Headaches were studied in a series of 49 patients with single or multiple transient ischaemic attacks (TIAs) followed up for 27 +/- 17 months. Forty-two patients had a CT scan and 38 had a Duplex-Scan. Twelve patients (24%) had TIA-related headaches, mostly in close temporal relation to the ischaemic onset. Headaches were more frequent in females and in vertebrobasilar TIA. Headache predominated in patients taking vasodilators when TIA occurred, or with orthostatic hypotension at the first clinical examination, suggesting that haemodynamic mechanisms are of importance in this respect. Bilateral/median pain predominated, especially but not exclusively in patients with vertebrobasilar territory TIAs. Arterial hypertension or a personal history of migraine were not more frequent in patients with headache. Patients with multiple TIAs had stereotyped headaches. Data suggest that headache and transient ischaemia are closely related. Reflex mechanisms may induce pain far from the ischaemic territory.