Vascular Headache

Migraine is often referred to as a “vascular headache.”  This is an outdated term regarding migraine and is not in the International Classification of Headache Disorders 3 Beta.  However, I do think it is a useful term to use with other types of headache related to arterial vasodilation.

The anatomical vascular structures in the body are arteries and veins.  Veins passively return blood to the heart and have one-way valves for flow.  The muscular heart provides the pump to put blood into arteries which goes to the foot or the brain.  Migraine and vascular in this sense refer to cerebral arteries.  During a migraine attack the cerebral arteries vasodilate due to action from the autonomic nervous system and circulating neurochemicals.  Then, when the heart pumps and the cerebral arteries dilate, that hurts.  Vascular headache pain is rhythmic and comes with the pulse. 

Types of vascular headache:

Migraine a genetic, inherited problem; you’re born with it and die with it, unless in the future medical treatment allows gene manipulation for treatment of migraine.  All migraines are vascular headaches.

A hangover a term meaning someone who drinks too much, gets drunk, goes to sleep, and then awakens the next day feeling awful while complaining of a bad, generalized, throbbing headache.  Certain alcoholic drinks promote vasodilation and headache.  Red wine may give a “headache at the end of a drink” to a migraine patient.

Caffeine withdrawal headache usually occurs within hours or a half a day of stopping a significant dose of daily caffeine and untreated can last 2 weeks.  This is medication overuse headache caused by caffeine.  A similar medication withdrawal headache occurs with pseudoephedrine (sudafed) which is found in many sinus/decongestant medications.  Pseudoephedrine is the “D” in Tylenol D.  According to articles in the American Headache Society caffeine is the most common over the counter cause of medication overuse headache.  During a migraine not treated with a triptan, the neurochemicals that are released may last 3 days.  Then after a migraine starts the arteries are dilated and inflamed every time the patient takes caffeine causing 3 more days of neurochemicals to be released.  See the article on medication overuse headache and the migraine timing cycle.  Drugs like nitroglycerin, used to treat angina, a cardiac condition due to atherosclerotic cardiovascular disease, can cause a “vascular headache” in normal persons which would be worse in a migraine patient.  Also, MSG, saccharin, aspartame, sulfites, benzoic acid, and nitrates can do this.  See the article medications or foods that can aggravate migraine.

Fever as can occur with any illness such as an upper respiratory infection.  The face of a person with fever may be flushed and red.  The tiny arteries in the skin of the face are vasodilated and the same thing happening in the brain may cause headache.

Concussion, Post-concussion Syndrome usually is limited to weeks or months due to direct brain trauma and also the release of cerebral neurochemicals.  The other unspoken, unpondered, and unsuspected problem is that the concussed patient starts taking analgesics for the headache, or if he sees a doctor he may be given butalbital, a large dose of an NSAID like 500 mg Motrin, or an opioid.  When and how often that simple head injury turns into medication overuse headache is a mystery, dependent on whether the patient has a genetic risk for migraine and the kind of drugs he may take and how often he takes them.

Mountain or Decompression Sickness occurs because the brain has baroreceptors, a neural device that senses barometric pressure change and then can set off a migraine.   Mountain or decompression sickness are headaches set off by these baroreceptors, which are naturally worse with migraine patients and medication overtreatment.

Meningitis headache

Medication overuse headache--see the webpage article on this for more detail.