Vascular headache is a group of conditions that involve the dilation or swelling of blood vessels that cause headache pain. The blood vessels in the head become enlarged, distended and inflamed, which alters the normal pulsation of the vessels and leads to a throbbing pain that usually worsens with physical activity.
Vascular headache is one of the four major types of headache, alongside muscle contraction (tension), traction and inflammatory headache. Migraine is the most common type of vascular headache and is more likely to affect women than men.
Types of Vascular Headache
There are several types of headaches that can be classified as a vascular headache, including:
- Classic migraine
- Cluster headache
- Common migraine
- Hemiplegic migraine
- Ophthalmoplegic migraine
- Basilar artery migraine
- Benign exertional headache
- Status migrainous
- Toxic headaches.
The characteristics of vascular headache depend on the specific type of headache presenting case.
Migraine is the most common type of vascular headache and involves severe pain in the head, which may be unilateral or bilateral, that lasts for 4 to 72 hours. This may be accompanied by several other signs and symptoms, including:
- Nausea and vomiting
- Altered vision
A migraine often begins with a premonition phase, with mood or behavior changes in the period before the symptoms begin. This may be followed by the aura phase for some types of migraine, with distinct visual, sensory or motor symptoms. The throbbing pain of the migraine then occurs, often accompanied by additional symptoms such as nausea and sensitivity to light. As the pain resolves the resolution phase often involves considerable fatigue, lack of concentration and irritability.
Cluster headaches usually involve episodes of intense pain, which is thought to be associated with hypertension.
Types of vascular headache may be diagnosed based upon the presenting symptoms and a physical exam. It is useful if the patient records the nature of the condition in a headache diary for a period of time to help the health practitioner to obtain a more complete understanding of their condition.
Important information that will help in the diagnosis includes information about the headaches, such as time of attacks, location of the pain, description of the pain, duration of the pain, and frequency of the pain. Other factors that may help in the diagnosis of the condition include behavioral changes and other symptoms that present with attacks.
There are some diagnostic tests that can also help to confirm diagnosis of vascular headaches. This may include blood tests, X-rays, magnetic resonance imaging (MRI), computer tomography (CT) scan or a lumbar puncture.
The treatment of vascular headaches depends on the specific characteristics of the condition and there are several factors that should be considered. These may include medical and family history, frequency and severity of symptoms, tolerance for medications and therapies, expected treatment outcomes and personal preferences.
Lifestyle alterations, particular in reducing activities with a high level of stress and prioritizing a healthy diet can make a significant difference in the frequency and severity of vascular headaches. Other treatment options for vascular headache may include:
- Biofeedback training
- Stress reduction
- Nutritional modifications
- Physical therapy
- Pressure therapy
- Cold packs
The first-line treatment options for vascular headaches in pharmacotherapy include analgesic medications, such as paracetamol, ibuprofen and aspirin. For severe pain that is not relieved by these medications, there are specific options that are indicated for the relief of pain associated with migraines. Additionally, preventative medications can help to reduce the frequency of vascular headaches for individuals that often suffer from severe attacks.