Cephalic Hyperemia During Migraine Headaches. A Prospective Study

SYNOPSIS
For the past 6 years, patients with headaches followed and treated by this laboratory have undergone ateach visit serial measurements of regional cephalic blood flow (rCBF) with neurological and medicalexaminations, direct interviews and completion of questionnaires regarding type, frequency, presence andseverity of head pain. Of 369 patients referred with recurrent headaches, 324 were classified classic,common, or complicated migraine, either alone or in combination with muscle contraction headaches(mixed headaches) and 45 were considered to have pure muscle contraction headaches. For purposes ofthis report, patients with cluster headaches were excluded. Forty-two percent (136) complained ofheadaches at the time or rCBF measurements. Of these 136, 60 cases had paired CBF measurementsduring headache and when headache-free and comprise the case material analyzed. Most headaches (61%)occurred during the initial visit. During spontaneous migraine headaches, rCBF increases (hyperemia)were present among 58% of patients classified as classic migraine, 53% classified as common migraine,25% classified as complicated and 31% classified as mixed. Cephalic blood flow values were reducedduring prodromes of classic migraine. Patchy zones of oligemia and hyperemia appeared at the onset ofheadache. Cephalic hyperemia usually returned to normal values a few days after headaches subsided.During headache, 32% of the patients showed gross dysautoregulation with paradoxical flow increasesduring 100% oxygen inhalation. Results are consonant with a vascular pathogenesis for prodromes andheadaches of migraine.