Overview of Migraines and Secondary Vascular Headaches

Today, an antiquated term, “vascular headache” was used in the past to describe a migraine. Experts believed that the throbbing sensation of a migraine was due to mechanical changes in the blood vessels that surround the head.

Over the past two decades, the process of thinking about the biology of a migraine attack has shifted from a vascular to a neural process.

Specifically, research now suggests that migraines stem from an imbalance of brain chemicals and nerve-related issues. Any blood vessel changes that occur with a migraine are considered a side effect and are not enough on their own to cause a headache.

Despite the fact that migraine is no longer synonymous with the term ‘vascular headache’, secondary vascular headaches do exist. These headaches are described by the International Headache Society as “headaches attributed to cranial or cervical vascular disorders”.

This article provides an overview of the diagnosis and treatment of migraines and secondary vascular headaches. It also reviews when you should see a health care provider for your headache.

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What is a migraine?

Migraines affect around 10% of the world’s population and are thought to be caused by the activation of pain receptors in the trigeminovascular system. The trigeminovascular system is made up of fibers from the trigeminal nerve that connect to blood vessels that supply the brain.

The trigeminal nerve is the largest of the 12 cranial nerves. During a migraine, its nerve fibers release substances that irritate and cause swelling of blood vessels in the brain.

Migraines are debilitating, throbbing and worsen with physical activity. They are usually located on one side of the head and may be accompanied by nausea, vomiting, and sensitivity to light, sound, or smell.

Besides a headache, some people also experience other phases during a migraine attack. These phases include:

  • The prodrome phase develops before the headache for hours or days and is associated with a variety of symptoms such as low mood, irritability, fatigue and neck discomfort.
  • A migraine aura occurs just before the headache and lasts for up to an hour. It is associated with reversible neurological disorders, such as seeing flashes of light or experiencing numbness or tingling sensations.
  • The postdrome phase of a migraine attack occurs after the headache and lasts 24 to 48 hours. During this phase, most people report feeling exhausted or as if in a fog.

migraine triggers

Commonly reported triggers of a migraine include hormonal changes, certain foods, weather, stress, alcohol, skipping meals, and trouble sleeping.

Diagnostic

A diagnosis of migraine is primarily determined by a careful medical history and examination.

Your healthcare provider will review the characteristics of your headache (for example, location, quality, and severity) and ask if you have other symptoms such as nausea, sensitivity to light, or sweating facial. They will also look at triggers and your family history.

For patients with suspected migraines, brain imaging is usually not indicated unless worrisome features are present or there is something abnormal on neurological examination.

Treatment

Treatment for migraines includes lifestyle modifications, medications, or a combination. Preventive strategies like avoiding triggers or taking medications are used to decrease the number and severity of headache attacks.

Mild to moderate migraines can be treated with a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) or Aleve (naproxen sodium), while more severe headaches usually require a triptan, like Imitrex (sumatriptan), or an NSAID/triptan combination, such as Treximet (sumatriptan and naproxen sodium).

For migraine sufferers who cannot take or tolerate a triptan, a calcitonin gene-related peptide (CGRP) blocker, such as Nurtec ODT (rimegepant), may be recommended.

What are secondary vascular headaches?

Secondary vascular headaches are usually throbbing or thunderclap in nature. They start suddenly and get worse quickly.

According to the International Headache Society, these headaches can result from any of the following various blood vessel pathologies:

Diagnostic

Secondary cluster headaches can be dangerous, even life-threatening, and can mimic primary headaches, such as migraine or cluster headache.

If a secondary vascular headache is suspected, an imaging test such as computed tomography (CT) of the brain or magnetic resonance imaging (MRI) of the brain and its blood vessels will be done.

Other tests that may be ordered to identify the cause of the headache include:

Treatment

Treatment for a secondary vascular headache depends on the underlying diagnosis.

For example, high doses of corticosteroids are used to treat giant cell arteritis. More dangerous headaches like strokes require monitoring in a hospital, intravenous (IV) medications, and sometimes surgery.

When to consult a doctor

Most headaches can be managed at home and are not alarming. In some cases, however, a headache may be the only clue that something serious is going on in your body.

Scenarios that warrant a visit or call to your healthcare provider include:

  • Your headache pattern changes (for example, becomes more severe or occurs more often).
  • Your headaches interfere with your daily activities.
  • You have a new headache and are over 65, pregnant or postpartum, or have a history of cancer or human immunodeficiency virus (HIV).
  • Your headache is triggered by coughing, exercise, or the Valsalva maneuver (a breathing technique that can slow down a rapidly beating heart).
  • You suffer from headaches associated with taking painkillers on a regular basis.

Seek emergency care

Go to the emergency room or call 911 if your headache:

  • Is severe, starts suddenly and/or is the “worst headache of your life”
  • Is severe and accompanied by a painful red eye, vision changes, high fever, stiff neck, or confusion
  • Is associated with symptoms of a possible stroke (eg, weakness, numbness, slurred speech)
  • Occurs after a head injury

Summary

Vascular headache is an outdated term previously used to describe migraines. Migraine attacks are now thought to stem primarily from nerve problems in the brain, not from changes in blood vessels.

Although the term “vascular headache” is no longer used, secondary vascular headaches do exist. These are headaches that result from a blood vessel problem in the head or neck, such as a stroke or a tear in a blood vessel.

A word from Verywell

If you suffer from migraines, it is important to understand what causes them. To help your healthcare provider make the correct diagnosis, start by taking notes (on paper or on your phone) about your headache patterns.

Include things like the time of day your headaches occur, how long they lasted, how severe they were, and the symptoms you experienced before, during, and after the headaches. It’s also a good idea to write down your sleep and meal times. This will help identify possible headache triggers.

Frequently Asked Questions

  • Can increased blood flow lead to headaches?

    Changes in blood flow in the brain, along with other chemical changes, can contribute to the development of a headache (including a migraine).

  • Does your brain swell when you have a headache?

    Brain swelling is a life-threatening condition. It can result from a head injury, brain tumor, brain infection, or stroke. Although a headache is a symptom of brain swelling, a headache by itself does not cause brain swelling.

  • Can migraines be seen on an MRI?

    Migraines cannot be seen or diagnosed by an MRI. The diagnosis of migraine is clinical, which means it is based on a person’s symptoms. That said, an MRI may be ordered as part of the diagnostic process to help rule out other neurological conditions.

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