Headache of vascular genesis

Description:

The headache type connected with different options of kraniotserebralny arteriovenous dystonia.

Symptoms of the Headache of vascular genesis:

Arteriodilatatorny (arteriogipotonichesky) the option of vascular type of a headache is connected with decrease in a tone of kraniotserebralny arteries. It leads them to excess stretching the pulse volume of blood. Thus, the so-called pulsing headache is not a symptom of vascular pain in general, but only its arteriodilatatorny option. Excess pulse stretching of a gipotonichny arterial wall can occur and at the normal level of system arterial pressure, however is more frequent - at its increase. If the artery of soft covers of the head is exposed to excess pulse stretching (for example, a superficial, temporal artery), then the prelum of its bringing trunk in temporomalar area a finger can reduce a throbbing pain.
  In certain cases loss of an autoregulyation extends to arteriovenous shunts which at the same time inadequately extend, and then an arterial blood, passing a capillary bed, comes to veins. Intravascular pressure, unusual to veins, adds to an arterial throbbing pain and a venous component, uncharacteristic for actually venous pain.
  Extreme degree of arterial hypotonia - paretic arterial dilatation (loss of an autoregulyation of arteries) - is followed by disturbance of permeability and plasmatic treatment of an arterial wall, perivascular hypostasis. In these conditions amplitude of a pulsation decreases and the headache can lose the pulsing character. The throbbing pain is replaced stupid, gains the aching or arching character. Allogenic vazoneyroaktivny substances which at disturbance of permeability together with plasma get into a vascular wall and perivascular fabric take part in genesis of such pain.
  The Arteriospatichesky option of vascular type of a headache comes at "spasm" of kraniotserebralny arteries. From the practical point of view, it is possible to mean such extent of increase in an arterial tone which involves an ischemic distsirkulyation and an ischemic hypoxia by arterial "spasm". The headache at the same time can have the aching and stupid character, be perceived as feeling of a prelum, to be followed by faintness, nausea, not rotatory vertigo, blackout, "black front sights" before eyes.
  The venous option of vascular type of a headache (differently - headache venous insufficiency) is caused by an excess krovenapolneniye of venous vessels (veins and venous sine) and difficulty of venous outflow. Patients test weight in the head and feeling of a stupid raspiraniye. In certain cases these feelings are limited to occipital area where the place of merge of intracranial venous vessels is projected. However because of a multiple anastomosis of intracranial veins these feelings generalizutsya usually on all head. Venous outflow is more effectively carried out in vertical position when the direction of gravity (the mass of blood in vessels) matches the direction of venous outflow tracts (jugular veins). Therefore headache venous insufficiency arises or amplifies in a prone position, work with low hung head, at a natuzhivaniye or cough. One of characteristic simtom headacheof venous insufficiency is the morning headache ("the heavy head as soon as opened eyes in the morning"). Insufficiency of a tone of veins and venous outflow is confirmed by an eyeground phlebectasia, cyanosis mucous a nose and a stomatopharynx, pastosity of the person, in particular a century (especially lower).
  Character of a kraniotserebralny angiodystonia can be objektivizirovat by means of a rheoencephalography (REG) which indicators reflect a condition of a tone of arteries and veins, and also venous outflow. Not to be mistaken in assessment of these indicators and a role of these or those changes of a tone in genesis of a headache, it is necessary to make at least two records REG - during a headache and in the period of good health. It is necessary to remember that increase in a tone of kraniotserebralny arteries can have compensatory character and does not need correction by antispasmodics. For specification of a condition of a tone and definition of reactivity of kraniotserebralny arteries write down REG with pharmacological test (1/4 - 1/2 Tabulettaes Nitroglycerini under language). For specification of degree of venous insufficiency of REG write down in different provisions of a body: sitting, lying (with a pillow and without), with the head hung below a horizontal.
  Indirect information on a sotoyaniya of intracranial vessels can be obtained at a research of arteries and veins of an eyeground.
  The vascular type of a headache is observed at migraine, a regional kraniotserebralny form of vegeto-vascular dystonia, at arterial hypertension of different genesis including against the background of cerebral atherosclerosis, at system vasculites.
  

Reasons of the Headache of vascular genesis:

The vascular type of a headache is connected with different options of kraniotserebralny arteriovenous dystonia. These options of regional dystonia very often do not correlate with the main indicators of a system hemodynamics.

Treatment of the Headache of vascular genesis:

At arteriogipotonichesky option of vascular type of a headache, attacks of migraine appoint ergotamine, dihydroergotamine, суматриптан, and at vegeto-vascular dystonia - drugs of a ksantinovy row: Euphyllinum, пентоксифиллин, Xantinoli nicotinas. At arteriospastichesky option - the drugs having spasmolytic effect: phosphodiesterase inhibitors (papaverine, Nospanum), adenylatecyclase activators (Vinpocetine and other drugs of a small periwinkle), a-adrenergic blockers (Pyrroxanum, dihydroergotoxin, ницерголин), antagonists of calcium (nifedipine, нимодипин). At headache venous insufficiency drugs of a ksantinovy row are most effective. Efficiency of pathogenetic treatment of a vascular headache increases at adequate pharmacotherapy of a basic disease.
  When the vascular headache is caused by the combined option of arteriovenous kraniotserebralny dystonia, try to allocate a key link of a pathogeny and appoint adequate therapy the appropriate vasoactive means.