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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