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6.0:
Headache associated with vascular disorders
Multiple
types of headaches associated with different vascular disorders are
discussed
under the categories of the IHS (numbered) and additional types are
added (no numbers). Some are placed in separate sections
Referred
Ophthalmic Division Pain and Occlusion of the Posterior Cerebral Artery
Most
patients who suffer occlusion of a posterior cerebral artery experience
no pain; however, exceptions were reported by Knox and Cogan (1962).
They noted that a distinct ocular pain may be reported by some patients
with vascular accidents in the area of the ipsilateral posterior
cerebral artery (see also Safran and Roth, 1983). Knox and Cogan
described two cases, one in a man of 66 who had difficulty with vision
in his left eye and ophthalmic division pain for 2 days. His right eye
had been blind for nearly 60 years. He had been hypertensive for many
years. He had felt vaguely ill, and, on arising after an hour's rest, he
noticed that his vision was impaired in the right visual field. He
experienced at that time moderately severe pain in his left eye and
supraorbital area, associated with nausea. Knox and Cogan presumed that
the pain was referred from tentorial branches of the ophthalmic division
of the trigeminal nerve. Part of the blood supply of the tentorium is
contributed by small proximal branches of the posterior cerebral artery.
It should also be recalled that the dural sinuses of the tentorium and
some of the superficial cerebral veins, including the occipital vein,
are richly supplied by recurrent ophthalmic branches of the trigeminal
nerve (Feindel et al., 1960).
Ophthalmic
Division Pain with Internal Carotid Artery Occlusion
Headache
preceding internal carotid artery occlusion was first recognized by
Moniz et al. (1937) and later by others (Andrell, 1943; Fisher, 1951).
Fisher was the first to appreciate the frequency and characteristics. He
described eight patients, four of whom presented with ipsilateral
headache. In all four patients, the pain was most severe in or above the
eye. It was steady and neither throbbing nor pulsatile. Individual
episodes of eye pain lasted from 15 minutes to 1 week. The interval
between the onset of eye pain and stroke was frequently prolonged--in
one patient, the pain was ``excruciating'' and occurred intermittently
for 1 year prior to the stroke. In all patients, the eye pain invariably
ceased shortly after the stroke began.
Grindal
and Toole (1974) investigated the relationship between headache and
transient ischemic attacks in both the carotid and vertebrobasilar
systems. Headache or eye pain occurred in 25% of all patients but
was rarely the presenting symptom. Cohen and McNamara (1980) described a
63-year-old woman who presented with the acute onset of right eye pain
and was found to have a 95% stenosis of the ipsilateral internal carotid
artery. Following a right carotid endarterectomy, the patient's eye pain
resolved.
It is
assumed that the mechanism of this form of eye pain derives from
vascular compromise of either the dura or cerebral vessels, both of
which are pain sensitive (Fisher, 1968; Medina et al., 1975; Safran and
Roth, 1983). A similar mechanism may be responsible for the pain
associated with a Raeder's paratrigeminal neuralgia syndrome in two
patients who were found to have fibromuscular dysplasia (Cohen et al.,
1975). The relationship of this eye pain and the ophthalmodynia
periodica of Lansche (1964) is unclear.
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