Breath holding index in episodic primary headaches

Abstract

Background/Aim. Examination of cerebrovascular reactivity in patients with primary headaches is focused mainly on migraine, while the smaller number of studies deals with tensiontype and cluster headache, or comparison of cerebral haemodynamic in migraine and tension-type headache (TTH). In this study, we hypothesized that cerebrovascular reactivity differs among different types of episodic primary headaches. In order to prove that we aimed to compare the interictal cerebrovascular reactivity in patients with the episodic form of the three most common types of primary headaches using the breath holding test. Methods. Examination was performed in 243 patients, 100 migraineurs with aura (group I), 70 migraineurs without aura (group II), 38 patients with episodic tension-type headache (group III), 35 patients with episodic form of cluster headache (group IV) and 35 healthy controls (group V). The Doppler instrument was used for transcranial doppler (TCD) sonography and breath-holding test performance. Blood flow mean velocities (MV), pulsatility indices (PI) and breath-holding index (BHI) for middle cerebral artery among these groups were analyzed. Results. The mean velocities and pulsatility indices were not different in 4 groups of headache patients and controls. The BHI was found to be significantly greater in the migraineurs with aura (1.668 ± 0.269) compared with the patients with migraineurs without aura (1.411 ± 0.358, p = 0.005), tension type headache (1.401 ± 0.428, p = 0.035), cluster headache (1.203 ± 0.311, p < 0.01) and controls (1.195 ± 0.269, p < 0.01) showing an exaggerated reactivity to hypercapnia in patients with migraine with aura. Conclusion. In conclusion, our finding support the literature data that increased cerebrovascular reactivity is a feature of migraine with aura. Result of unchanged cerebrovascular reactivity in migraine without aura, cluster headache and tension-type headache is expected, still, it is possible that in future, using different technique, we will be able to put more light on vascular changes that are following different headache disorders.

Profiling cerebrovascular function in migraine: A systematic review and meta-analysis

“…Thirty-five studies were identified from the literature search that compared resting mean blood flow velocity (MBFV) in migraineurs to controls; 12,16–49 30 studies assessed MBFV in the anterior circulation. 12,19–24,26–32,34–49 All but four studies found no significant difference in MBFV in the anterior circulation between migraineurs and controls; Abernathy et al., Fiermonte et al., Karadas et al.…”

“…Twelve studies were identified from the literature search that used TCD ultrasound to compare PI in the anterior circulation of migraineurs and controls. 16,17,23,28,30,32,33,39,40,44–46 Nine of these studies found no significant difference in PI between migraineurs and controls. 16,17,23,28,30,32,39,44,46 Chernyshev et al.…”

“…Twenty-six studies compared cerebrovascular responsiveness (CVR) to hypercapnia in the anterior and posterior circulations of migraineurs with that of controls. 12 , 16,18,19,21,24,28,30,32,34,35,37,38,43,44,50–60 Various methods were used to induce hypercapnia: the breath-holding task (BHT), inhalation of carbogen gas, infusion of acetazolamide and infusion of L-arginine. Fourteen studies used the BHT to induce hypercapnia, wherein participants hold their breath for a specified duration, which results in an increase in arterial CO 2 and subsequent vasodilation of cerebral blood vessels.…”

“…Twenty-six studies compared CVR to hypercapnia in the anterior circulation between migraineurs and controls with mixed results; 10 studies found migraineurs to have higher CVR to hypercapnia, 16,21,30,32,35,50,51,54,58,59 five studies found migraineurs to have lower CVR to hypercapnia 19,37,43,44,56 and nine studies found no difference in CVR to hypercapnia in the anterior circulation between migraineurs and controls. 12 , 24,28,34,38,52,55,60 In Gonzalez-Quintanilla et al.…”

Objective Diagnosis of Migraine without Aura with Migraine Vascular Index: A Novel Formula to Assess Vasomotor Reactivity

“…Various studies have also proven that migraineurs have lower BHIs compared with nonmigraineurs (Silvestrini et al 2004;Rajan et al 2015;Lee et al 2019). Conflicting results, however, were obtained by Podgorac et al (2018) and Altamura et al (2018), who found that BHI is higher in migraine with aura than in non-migraineurs. Dora and Balkan (2002) also reported higher BHIs in migraineurs without aura.…”