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Κεφαλαλγία και αγγειακό εγκεφαλικό επεισόδιο (Master thesis)

Κρομμύδα, Μαρία

Headache is a milestone in cerebrovascular disorders. Indeed it may represent the only symptom at onset, predominates over the other neurological symptoms or overshadowed by them. Unfortunately, headache associated with cerebrovascular diseases lacks clear-cut characteristics as it may resemble a migraine attack, tension-type headache, or cluster headache. However is very important to analyze and describe the most common patterns of headache for different vascular disorders. Prompt recognition and treatment is usually needed for many conditions to avoid permanent sequelae that result in disability. A high index of clinical suspicion is necessary to diagnose the disorder. In ischemic stroke, headache when it exists, usually occurs in the onset of stroke and is more often in posterior circulation infracts. In intracerebral hemorrhage, headache is more frequent and in contrast to ischemic stroke, is associated with worse prognosis. Headache due to subarachnoid aneurysmal hemorrhage presents peculiar characteristics (thunderclap, acute presentation, and high intensity), whereas in cerebral vasoconstriction syndrome, the relapsing-remitting course of thunderclap headache is a key point for the diagnosis. In cervicocerebral artery dissection, pain is most commonly ipsilateral unilateral to the dissected vessel and is mainly perceived in the temporal area in case of carotid artery dissection and in the occipital area in case of vertebral artery dissection. In cerebral venous thrombosis, pain is often acute or subacute and severe and it may resemble a typical migraine attack. By the contrary, in primary angiitis of the central nervous system, pain is always subacute or chronic with mild to moderate intensity. In general, disorders in which headache is a prominent symptom may increase the risk of ischemic or hemorrhagic stroke and multiple secondary headache disorders may be associated with increased risk of stroke. Finally the primary headaches are not usually associated with increased stroke risk, with the notable exception of migraine with aura.