Cerebral blood flow in migraine accompaniments and vertebrobasilar ischemia.

Abstract

Transient neurological symptoms of brain stem or occipital lobe origin may be caused by transient ischemic attack in the vertebrobasilar territory (VB-TIA) or late-onset (or late-life) migraine accompaniment (LOMA). It is often clinically difficult to distinguish between VB-TIA and LOMA. Cerebral blood flow of 23 patients with VB-TIA, 24 with LOMA, and 28 age-matched control subjects was measured using the 133Xe inhalation regional cerebral blood flow (rCBF) technique. After adjusting for differences in baseline variables such as blood pressure, hematocrit, and PCO2, patients with VB-TIA had (1) lower mean rCBF than control subjects (P < .003) as measured by the initial slope index method; (2) more frequent anterior rCBF asymmetries than control subjects and patients with LOMA (P < .03 for both comparisons); and (3) higher mean interhemispheric rCBF differences compared with patients with LOMA (P = .08) and control subjects (P < .02). Regional CBF patterns in patients with VB-TIA and LOMA differ, with lower rCBF and more asymmetry of the anterior blood flows in patients with VB-TIA, probably reflecting the effects of stroke risk factors on the cerebral circulation. Patients with LOMA have rCBF patterns more closely resembling those of age-matched healthy subjects. rCBF measurements may assist in the clinical diagnosis of VB-TIA and late-onset migrainous events.

Cerebral Blood Flow in Chronic Posttraumatic Headache

“…12 Regional (rlFD) and mean (mIFD) interhemispheric flow differences were calculated as previously reported. 13 Also as reported previously, 13 the mean rIFD (± 2SD) was less than 7% in healthy controls and, therefore, a value ≥7% was considered regional asymmetry. Major regional asymmetry was considered present if the value was ≥10%.…”

Migraine in the elderly — diagnosis and treatment: a single-centre experience

“…The duration of migraine symptoms can be 5-60 minutes, but is usually about 20, whereas transient ischaemic attacks (TIA) are generally appreciably shorter lasting, or indeed longer. Posterior circulation TIA/stroke may have headache as one of the prodromal symptoms that precede stroke by days or weeks [13,14]. Different pathogenetic backgrounds imply different treatments [15].…”

Treatment of Headache in the Elderly

“…HA is present in about 50 % of patients who have migraine accompaniments, and a personal history and family history of migraine are often obtained from the patient. Regional cerebral blood flow patterns in those who have migraine accompaniments are more likely to resemble age-matched controls than those who have posterior circulation TIA [12]. Posterior circulation TIAs may have HA as one of the prodromal symptoms that precede stroke by days or weeks [13].…”