Headache in cerebrovascular diseases

Article Figures & Data

Table 1

Primary headaches and characteristics

Types	Characteristics
Migraine	Unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, association with nausea and/or photophobia and phonophobia, lasting from 4 to 72 hours.
Tension-type headache	Bilateral, pressing or tightening in quality and mild-to-moderate intensity, lasting from 30 min to 7 days.
Cluster headache	Severe in intensity, strictly unilateral to the orbital, supraorbital and temporal area or in any combination of these sites, lasting 15–180 min and occurring from once every other day to eight times a day.

Table 2

Headache attributed to cerebrovascular diseases with clinical and diagnostic features

Types	Headache features	Diagnostic features
SAH	Thunderclap, acute, severe, long-lasting	Non-contrast-enhanced CT: sensitivity 99% in the first 6 hours, CSF: erythrocytes or xanthochromia
PACNS	Chronic, moderate, diffuse, long-lasting	CSF: lymphocyte and protein increases, MRI: ischaemic lesions in subcortical and deep white matter and grey matter
CAD	Thunderclap, acute, unilateral	CT or MRA: long, irregular stenosis, an occlusion or a dissecting aneurysm
CVT	Acute or subacute, diffuse, long-lasting	MRI: detect brain parenchymal lesions; CT/CTV: high density consistent with the position of venous sinus
MELAS	Migrainous headaches, short-lasting, mild or moderate	MRI: lace sign or ribbon sign
CADASIL	Migraine with (atypical) aura	MRI: white matter hyperintensities in the anterior temporal pole, lacunes; genetic testing: NOTCH3 mutation
RCVS	Thunderclap, acute, severe, relapsing	Angiography: segmental narrowing of branches of cerebral arteries

CAD, cervical artery dissection; CADASIL, cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy; CSF, cerebrospinal fluid; CTV, CT venography; CVT, cerebral venous thrombosis; MELAS, mitochondrial encephalomyopathy, lactic acidosis and stroke-like episode syndrome; MRA, magnetic resonance angiography; PACNS, primary angiitis of the central nervous system; RCVS, reversible cerebral vasoconstriction syndrome; SAH, subarachnoid haemorrhage.

Vol 5 Issue 2 Table of Contents