Vascular headache
Posted by recep on April 19th, 2009Vascular headache: In the elderly, a vascular headache may result from temporal arteritis or a migraine. When a headache has a recent onset and is associated with hip-girdle pain, jaw claudication, fatigue, or visual changes, the physician should suspect temporal arteritis and obtain an erythrocyte sedimentation rate. If the erythrocyte sedimentation rate is elevated or if suspicion is high before the test results are known, prednisone 60 mg/day should be initiated, and a temporal artery biopsy should be obtained as soon as possible (see also Ch. 74).
Migraine headaches may occur at any age but do not commonly begin in later life. The headache is often preceded by an aura of flashing bright lights in a vertical zigzag or picket-fence configuration, either to the far left or far right of both visual fields, and is always bilateral. This aura may be followed by severe, pounding, relentless pain on the opposite side of the head. The pain is exacerbated by bright lights or movement and eased by lying down in the dark. The aura is caused by marked cerebral vasoconstriction involving vessels of the visual cortex, and the pain results from marked secondary vasodilation (with associated stretching of perivascular nerve endings).
Prophylaxis with a ?-blocker or calcium channel blocker may prevent the attack by blocking vasoconstriction. Effective treatment consists of taking ergotamine at the onset of the aura to abort the attack by maintaining vasoconstriction. Once headache supervenes, analgesics and rest are indicated. An injection of sumatriptan may ameliorate the symptoms.
Tags: Vascular headache
