Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

Headaches of vascular origin

Authors: A.G. Ayroyan, M.V. Shumilina

Bakoulev National Scientific and Practical Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.


UDC: 616.857

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (2): 65-73

Quote as: Ayroyan A.G., Shumilina M.V. Headaches of vascular origin. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (2): 65–73 (in Russ.). DOI: 10.24022/1814-6910-2017-14- 2-65-73

Received / Accepted:  28.02.2017/03.03.2017

Full text:  


In the present review describes the main official nosological forms in which headache is the result of a pathological process involving the blood vessels of the brain. Summarized modern data of etiology, pathogenesis, clinical picture of vascular headaches.
Presented angiological look at the reasons for the development of a number of primary and secondary headaches, which are based on violations of cerebral venous outflow that can occur in systemic or regional phlebohypertensions: caused by anomalies of the structure of intra- and extracranial (brachiocephalic) of the venous system, arteriovenous imbalance.


1. Schwedt T.J., Matharu M.S., Dodick D.W. Thunderclap
headache. Lancet Neurol. 2006; 5 (7): 621–31.
2. Yew K.S., Cheng E.M. Diagnosis of acute stroke. Am.
Fam. Physician. 2015; 91 (8): 528–36.
3. Spitzer C., Mull M., Rohde V., Kosinski C.M. Non-traumatic
cortical subarachnoid haemorrhage: diagnostic
work-up and aetiological background. Neuroradiology.
2005; 47 (7): 525–31.
4. Ducros A., Bousser M.-G. Reversible cerebral vasoconstriction
syndrome. Pract. Neurol. 2009; 9: 256–67.
5. Sheikh H.U. Headache in intracranial and cervical
artery dissections. Curr. Pain Headache Rep. 2016; 20
(2): 8.
6. Debette S., Compter A., Labeyrie M.A., Uyttenboogaart
M., Metso T.M., Majersik J.J. et al. The clinical
and radiological spectrum of reversible cerebral
vasoconstriction syndrome. A prospective series of 67
patients. Brain. 2007; 130: 3091–101.
7. Saposnik G., Barinagarrementeria F., Brown R.D. Jr,
Bushnell C.D., Cucchiara B., Cushman M. et al.
Diagnosis and management of cerebral venous thrombosis:
a statement for healthcare professionals from the
American Heart Association, American Stroke
Association. Stroke. 2011; 42 (4): 1158–92.
8. Bushnell C., Saposnik G. Evaluation and management
of cerebral venous thrombosis. Continuum (Minneap
Minn). Cerebrovasc. Dis. 2014; 20 (2): 335–51.
9. The International Classification of Headache
Disorders, 3rd edition (beta version). Headache
Classification Committee of the International
Headache Society (IHS). Cephalalgia. 2013; 33 (9):
10. Schoonman G.G., van der Grond J., Kortmann C.,
van der Geest R.J., Terwindt G.M., Ferrari M.D.
Migraine headache is not associated with cerebral or
meningeal vasodilatation – a 3T magnetic resonance
angiography study. Brain. 2008; 131 (Pt 8): 2192–200.
11. Buture A., Gooriah R., Nimeri R., Ahmed F. Current
understanding on pain mechanism in migraine and
cluster headache. Anesth. Pain Med. 2016; 6 (3):
12. Lee M.J., Lee C., Chung C.S. The Migraine-stroke
connection. Stroke. 2016; 18 (2): 146–56.
13. Guidetti D., Rota E., Morelli N., Immovilli P.
Migraine and stroke: "vascular" comorbidity. Front
Neurol. 2014; 5: 193.
14. Bougea A., Anagnostou E., Spandideas N., Triantafyllou
N., Kararizou E. An update of neurological manifestations
of vasculitides and connective tissue diseases:
a literature review. Einstein (Sao Paulo). 2015; 13 (4):
15. Pfadenhauer K., Roesler A., Golling A. The involvement
of the peripheral nervous system in biopsy proven
active giant cell arteritis. J. Neurol. 2007; 254 (6):
16. Younger D.S. Vasculitis of the nervous system. Curr.
Opin. Neurol. 2004; 17 (3): 317–36.
17. Ribi C., Cohen P., Pagnoux C., Mahr A., Are`ne J.P.,
Puéchal X. et al. Treatment of polyarteritis nodosa and
microscopic polyangiitis without poor-prognosis factors:
a prospective randomized study of one hundred
twenty-four patients. Arthritis Rheum. 2010; 62 (4):
18. Moore P.M. Diagnosis and management of isolated
angiitis of the central nervous system. Neurology. 1989;
39 (2 Pt 1): 167–73.
19. Serdaru M., Chiras J., Cujas M., Lhermitte F. Isolated
benign cerebral vasculitis or migrainous vasospasm?
J. Neurol. Neurosurg. Psychiatry. 1984; 47 (1): 73–6.
20. Greenberg B.M. The neurologic manifestations of systemic
lupus erythematosus. Neurologist. 2009; 15 (3):
21. Streifler J.Y., Molad Y. Connective tissue disorders: systemic
lupus erythematosus, Sjögren's syndrome, and
scleroderma. Handb. Clin. Neurol. 2014; 119: 463–73.
22. Patzig M., Laub C., Janssen H., Ertl L., Fesl G.
Pseudo-subarachnoid haemorrhage due to chronic
hypoxaemia: case report and review of the literature.
BMC Neurol. 2014; 14: 219.
23. Calabrese L.H., Dodick D.W., Schwedt T.J., Narrative
review: reversible cerebral vasoconstriction syndromes.
Ann. Intern. Med. 2007; 146: 34–44.
24. Bartynski W.S. Posterior reversible encephalopathy syndrome,
part 1: fundamental imaging and clinical features.
Am. J. Neuroradiol. 2008; 29: 1036–42.
25. Joutel A., Corpechot C., Ducros A., Vahedi K.,
Chabriat H., Mouton P. et al. NOTCH3 mutations in
CADASIL, a hereditary adult-onset condition causing
stroke and dementia. Nature. 1996; 383 (6602): 707–10.
26. Chabriat H., Joutel A., Dichgans M., Tournier-
Lasserve E., Bousser M.G. Cadasil. Lancet Neurol.
2009; 8 (7): 643–53.
27. Tournier-Lasserve E., Iba-Zizen M.T., Romero N.,
Bousser M.G. Autosomal dominant syndrome with
strokelike episodes and leukoencephalopathy. Stroke.
1991; 22 (10): 1297–302.
28. Tikka S., Mykkänen K., Ruchoux M.M., Bergholm R.,
Junna M., Pöyhönen M. et al. Congruence between
NOTCH3 mutations and GOM in 131 CADASIL
patients. Brain. 2009; 132 (Pt 4): 933–9.
29. Shirley M.D., Tang H., Gallione C.J., Baugher J.D.,
Frelin L.P., Cohen B. et al. Sturge-Weber syndrome and
port-wine stains caused by somatic mutation in GNAQ.
N. Engl. J. Med. 2013; 368 (21): 1971–9.
30. Maton B., Krsek P., Jayakar P., Resnick T., Koehn M.,
Morrison G. et al. Medically intractable epilepsy in
Sturge-Weber syndrome is associated with cortical malformation:
implications for surgical therapy. Epilepsia.
2010; 51 (2): 257–67.
31. Evans A.L., Widjaja E., Connolly D.J., Griffiths P.D.
Cerebral perfusion abnormalities in children with
Sturge–Weber syndrome shown by dynamic contrast
bolus magnetic resonance perfusion imaging. Pediatrics.
2006; 117 (6): 2119–25.
32. Comi A.M. Presentation, diagnosis, pathophysiology, and
treatment of the neurological features of Sturge–Weber
syndrome. Neurologist. 2011; 17 (4): 179–84.
33. Беляев А.Ю., Усачев Д.Ю., Лукшин В.А., Cазоно-
ва О.Б., Шмигельский А.В., Подопригора А.Е.
Синдром церебральной гиперперфузии после ка-
ротидной эндартерэктомии. Журнал «Вопросы ней-
рохирургии» имени Н.Н. Бурденко. 2011; 3: 31–8.
34. Sundt T.M. Jr, Sharbrough F.W., Piepgras D.G.,
Kearns T.P., Messick J.M. Jr, O'Fallon W.M.
Correlation of cerebral blood flow and electroencephalographic
changes during carotid endarterectomy:
with results of surgery and hemodynamics of cerebral
ischemia. Mayo Clin. Proc. 1981; 56 (9): 533–43.
35. Barbetta I., Carmo M., Mercandalli G., Lattuada P.,
Mazzaccaro D., Settembrini A.M. et al. Outcomes of
urgent carotid endarterectomy for stable and unstable
acute neurologic deficits. J. Vasc. Surg. 2014; 59 (2):
36. Hines G.L., Oleske A., Feuerman M. Post-carotid
endarterectomy hyperperfusion syndrome – is it predictable
by lack of cerebral reserve? Ann. Vasc. Surg.
2011; 25 (4): 502–7.
37. Крайник В.М., Козлов С.П. Острые реперфузион-
ные повреждения центральной нервной системы
при операциях на внутренних сонных артериях.
Вестник анестезиологии и реаниматологии. 2011; 2:
38. Maas M.B., Kwolek C.J., Hirsch J.A., Jaff M.R.,
Rordorf G.A. Clinical risk predictors for cerebral
hyperperfusion syndrome after carotid endarterectomy.
J. Neurol. Neurosurg. Psychiatry. 2013; 84 (5): 569–72.
39. Ballesteros-Pomar M., Alonso-Argüeso G., Tejada-
García J., Vaquero-Morillo F. Cerebral hyperperfusion
syndrome in carotid revascularisation surgery. Rev.
Neurol. 2012; 55 (8): 490–8.
40. Ogasawara K., Sakai N., Kuroiwa T., Hosoda K.,
Iihara K., Toyoda K. et al. Intracranial hemorrhage
associated with cerebral hyperperfusion syndrome following
carotid endarterectomy and carotid artery stenting:
retrospective review of 4494 patients. J. Neurosurg.
2007; 107 (6): 1130–6.
41. Wu T.Y., Anderson N.E., Barber P.A. Neurological
complications of carotid revascularisation. J. Neurol.
Neurosurg. Psychiatry. 2012; 83 (5): 543–50.
42. Hayashi K., Horie N., Suyama K., Nagata I. Incidence
and clinical features of symptomatic cerebral hyperperfusion
syndrome after vascular reconstruction. World
Neurosurg. 2012; 78 (5): 47–54.
43. Chang C.H., Chang T.Y., Chang Y.J., Huang K.L.,
Chin S.C., Ryu S.J. et al. The role of perfusion computed
tomography in the prediction of cerebral hyperperfusion
syndrome. PLoS One. 2011; 6 (5): e19886.
44. Kawai N., Hatakeyama T., Okauchi M., Kawanishi M.,
Shindo A., Kudomi N. et al. Cerebral blood flow and
oxygen metabolism measurements using positron emission
tomography on the first day after carotid artery
stenting. J. Stroke Cerebrovasc. Dis. 2014; 23 (2):
45. Kim K.H., Lee C.H., Son Y.J., Yang H.J., Chung Y.S.,
Lee S.H. Post-carotid endarterectomy cerebral hyperperfusion
syndrome: is it preventable by strict blood
pressure control? J. Korean Neurosurg. Soc. 2013; 54
(3): 159–63.
46. Wada H., Saito M., Kamada K. Evaluation of changes
of intracranial blood flow after carotid artery stenting
using digital subtraction angiography flow assessment.
World J. Radiol. 2015; 7 (2): 45–51.
47. Табеева Г.Р. Головная боль: Руководство для врачей.
М.: ГЭОТАР-Медиа; 2014.
48. Шумилина М.В., Спиридонов А.А., Бузиашви-
ли Ю.И. Изучение церебральной гемодинамики
при цефалгическом синдроме. Грудная и сердечно-
сосудистая хирургия. 1996; 6: 139–40.
49. Шумилина М.В., Спиридонов А.А., Бузиашви-
ли Ю.И., Алекян Б.Г., Амбатьелло С.Г. Дисбаланс
венозного церебрального кровообращения в генезе
энцефалопатий у больных с сердечно-сосудистыми
заболеваниями. Анналы хирургии. 2001; 4: 62–7.
50. Шумилина М.В. Нарушения венозного цереб-
рального кровообращения у больных с сердечно-
сосудистой патологией: Дис. … д-ра мед. наук. М.;
51. Бокерия Л.А., Бузиашвили Ю.И., Шумилина М.В.
Нарушения венозного церебрального кровообра-
щения у больных с сердечно-сосудистой патологи-
ей. Головная боль, ишемия мозга, артериосклероз.
М.: НЦССХ им. А.Н. Бакулева; 2003.
52. European principles of management of common
headache disorders in primary care. J. Headache Pain.
2007; 8 (Suppl. 1).
53. Шумилина М.В. Комплексная ультразвуковая диа-
гностика патологии периферических сосудов. М.:
НЦССХ им. А.Н. Бакулева; 2012.
54. Шумилина М.В. Нарушения венозного кровообра-
щения у пациентов с сердечно-сосудистой патоло-
гией. Клиническая физиология кровообращения. 2013;
3: 5–16.

About Authors

  • Ayroyan Astine Genrikovna, Research Associate;
  • Shumilina Margarita Vladimirovna, MD, PhD, DSc, Chief of Group of Ultrasound Cardiovascular and Organ Pathology

 If you found mistakes, select text and press Alt+A