Skip to main content

Advertisement

SpringerLink
Log in

Neuroimaging of Headaches Associated with Vascular Disorders

  • Imaging (L Mechtler, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Headaches from vascular causes need to be differentiated from primary headaches because a misdiagnosis may lead to dire consequences for the patient. Neuroimaging is critical in identifying patients with vascular headaches and identifying the nature of the pathologic disorder causing these headaches. In addition, the imaging findings guide the physician regarding the optimal treatment modality for these lesions. This review summarizes the nuances of differentiating patients with secondary headaches related to vascular disease and discusses pertinent neuroimaging studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

Abbreviations

AVF:

Arteriovenous fistula

AVM:

Arteriovenous malformation

CE:

Contrast enhanced

CSF:

Cerebrospinal fluid

CT:

Computed tomographic

CTA:

Computed tomographic angiography

CVT:

Cerebral venous thrombosis

DSA:

Digital subtraction angiography

ECA:

External carotid artery

FLAIR:

Fluid-attenuated inversion recovery

GRE:

Gradient echo

ICA:

Internal carotid artery

ICH:

Intracranial hemorrhage

MR:

Magnetic resonance

MRA:

Magnetic resonance angiography

RCVS:

Reversible cerebral vasoconstriction syndrome

SAH:

Subarachnoid hemorrhage

SWI:

Susceptibility-weighted imaging

TOF:

Time-of-flight

VA:

Vertebral artery

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9–160.

    Google Scholar 

  2. Dodick DW. Pearls: headache. Semin Neurol. 2010;30(1):74–81.

    Article  PubMed  Google Scholar 

  3. Connolly Jr ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37. Good summary of current guidelines for diagnosis and management of SAH.

    Article  PubMed  Google Scholar 

  4. Bederson JB, Connolly Jr ES, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40(3):994–1025.

    Article  PubMed  Google Scholar 

  5. Linn FH, Wijdicks EF, van der Graaf Y, Weerdesteyn-van Vliet FA, Bartelds AI, van Gijn J. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994;344(8922):590–3.

    Article  CAS  PubMed  Google Scholar 

  6. Polmear A. Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. Cephalalgia. 2003;23(10):935–41.

    Article  CAS  PubMed  Google Scholar 

  7. Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med. 2000;342(1):29–36.

    Article  CAS  PubMed  Google Scholar 

  8. McCormack RF, Hutson A. Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? Acad Emerg Med. 2010;17(4):444–51.

    Article  PubMed  Google Scholar 

  9. Wang H, Li W, He H, Luo L, Chen C, Guo Y. 320-detector row CT angiography for detection and evaluation of intracranial aneurysms: comparison with conventional digital subtraction angiography. Clin Radiol. 2013;68(1):e15–20.

    Article  CAS  PubMed  Google Scholar 

  10. Romijn M, Gratama van Andel HA, van Walderveen MA, Sprengers ME, van Rijn JC, van Rooij WJ, et al. Diagnostic accuracy of CT angiography with matched mask bone elimination for detection of intracranial aneurysms: comparison with digital subtraction angiography and 3D rotational angiography. AJNR Am J Neuroradiol. 2008;29(1):134–9.

    Article  CAS  PubMed  Google Scholar 

  11. Zhang LJ, Wu SY, Niu JB, Zhang ZL, Wang HZ, Zhao YE, et al. Dual-energy CT angiography in the evaluation of intracranial aneurysms: image quality, radiation dose, and comparison with 3D rotational digital subtraction angiography. AJR Am J Roentgenol. 2010;194(1):23–30.

    Article  PubMed  Google Scholar 

  12. Ishihara H, Kato S, Akimura T, Suehiro E, Oku T, Suzuki M. Angiogram-negative subarachnoid hemorrhage in the era of three dimensional rotational angiography. J Clin Neurosci. 2007;14(3):252–5.

    Article  PubMed  Google Scholar 

  13. van Rooij WJ, Peluso JP, Sluzewski M, Beute GN. Additional value of 3D rotational angiography in angiographically negative aneurysmal subarachnoid hemorrhage: how negative is negative? AJNR Am J Neuroradiol. 2008;29(5):962–6.

    Article  PubMed  Google Scholar 

  14. Yuan MK, Lai PH, Chen JY, Hsu SS, Liang HL, Yeh LR, et al. Detection of subarachnoid hemorrhage at acute and subacute/chronic stages: comparison of four magnetic resonance imaging pulse sequences and computed tomography. J Chin Med Assoc. 2005;68(3):131–7.

    Article  PubMed  Google Scholar 

  15. Verma RK, Kottke R, Andereggen L, Weisstanner C, Zubler C, Gralla J, et al. Detecting subarachnoid hemorrhage: comparison of combined FLAIR/SWI versus CT. Eur J Radiol. 2013;82(9):1539–45.

    Article  PubMed  Google Scholar 

  16. Sailer AM, Wagemans BA, Nelemans PJ, de Graaf R, van Zwam WH. Diagnosing intracranial aneurysms with MR angiography: systematic review and meta-analysis. Stroke. 2014;45(1):119–26.

    Article  PubMed  Google Scholar 

  17. Bakker NA, Groen RJ, Foumani M, Uyttenboogaart M, Eshghi OS, Metzemaekers JD, et al. Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis. J Neurosurg. 2014;120(1):99–103.

    Article  PubMed  Google Scholar 

  18. Bruce BB, Biousse V, Newman NJ. Third nerve palsies. Semin Neurol. 2007;27(3):257–68.

    Article  PubMed  Google Scholar 

  19. Keane JR. Third nerve palsy: analysis of 1400 personally-examined inpatients. Can J Neurol Sci. 2010;37(5):662–70.

    Article  PubMed  Google Scholar 

  20. Goldenberg-Cohen N, Curry C, Miller NR, Tamargo RJ, Murphy KP. Long term visual and neurological prognosis in patients with treated and untreated cavernous sinus aneurysms. J Neurol Neurosurg Psychiatry. 2004;75(6):863–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Wiebers DO. Unruptured intracranial aneurysms: natural history and clinical management. Update on the international study of unruptured intracranial aneurysms. Neuroimaging Clin N Am. 2006;16(3):383–90. vii.

    Article  PubMed  Google Scholar 

  22. Jeong HW, Seo JH, Kim ST, Jung CK, Suh SI. Clinical practice guideline for the management of intracranial aneurysms. Neurointervention. 2014;9(2):63–71.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Stapf C, Mast H, Sciacca RR, Choi JH, Khaw AV, Connolly ES, et al. Predictors of hemorrhage in patients with untreated brain arteriovenous malformation. Neurology. 2006;66(9):1350–5.

    Article  CAS  PubMed  Google Scholar 

  24. Hernesniemi JA, Dashti R, Juvela S, Vaart K, Niemela M, Laakso A. Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients. Neurosurgery. 2008;63(5):823–9. discussion 9–31.

    Article  PubMed  Google Scholar 

  25. Ondra SL, Troupp H, George ED, Schwab K. The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. J Neurosurg. 1990;73(3):387–91.

    Article  CAS  PubMed  Google Scholar 

  26. Laakso A, Hernesniemi J. Arteriovenous malformations: epidemiology and clinical presentation. Neurosurg Clin N Am. 2012;23(1):1–6.

    Article  PubMed  Google Scholar 

  27. Gross BA, Du R. Natural history of cerebral arteriovenous malformations: a meta-analysis. J Neurosurg. 2013;118(2):437–43.

    Article  PubMed  Google Scholar 

  28. Mokin M, Dumont TM, Levy EI. Novel multimodality imaging techniques for diagnosis and evaluation of arteriovenous malformations. Neurol Clin. 2014;32(1):225–36. Good review of imaging techniques that help in the diagnosis and management of AVMs.

    Article  PubMed  Google Scholar 

  29. Strother CM, Bender F, Deuerling-Zheng Y, Royalty K, Pulfer KA, Baumgart J, et al. Parametric color coding of digital subtraction angiography. AJNR Am J Neuroradiol. 2010;31(5):919–24.

    Article  CAS  PubMed  Google Scholar 

  30. Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol. 2012;33(6):1007–13.

    Article  CAS  PubMed  Google Scholar 

  31. van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002;33(5):1233–6.

    Article  PubMed  Google Scholar 

  32. Natarajan SK, Ghodke B, Kim LJ, Hallam DK, Britz GW, Sekhar LN. Multimodality treatment of intracranial dural arteriovenous fistulas in the Onyx era: a single center experience. World Neurosurg. 2010;73(4):365–79.

    Article  PubMed  Google Scholar 

  33. Miller NR. Dural carotid-cavernous fistulas: epidemiology, clinical presentation, and management. Neurosurg Clin N Am. 2012;23(1):179–92.

    Article  PubMed  Google Scholar 

  34. Campbell PG, Jabbour P, Yadla S, Awad IA. Emerging clinical imaging techniques for cerebral cavernous malformations: a systematic review. Neurosurg Focus. 2010;29(3):E6.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Zabramski JM, Wascher TM, Spetzler RF, Johnson B, Golfinos J, Drayer BP, et al. The natural history of familial cavernous malformations: results of an ongoing study. J Neurosurg. 1994;80(3):422–32.

    Article  CAS  PubMed  Google Scholar 

  36. Steiger HJ, Markwalder TM, Reulen HJ. Clinicopathological relations of cerebral cavernous angiomas: observations in eleven cases. Neurosurgery. 1987;21(6):879–84.

    Article  CAS  PubMed  Google Scholar 

  37. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007;6(2):162–70.

    Article  CAS  PubMed  Google Scholar 

  38. Wasay M, Kojan S, Dai AI, Bobustuc G, Sheikh Z. Headache in cerebral venous thrombosis: incidence, pattern and location in 200 consecutive patients. J Headache Pain. 2010;11(2):137–9.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Crassard I, Bousser MG. Headache in patients with cerebral venous thrombosis. Rev Neurol (Paris). 2005;161(6–7):706–8.

    Article  CAS  Google Scholar 

  40. Bonneville F. Imaging of cerebral venous thrombosis. Diagn Interv Imaging. 2014;95:1145–50. Good review of imaging techniques for CVT.

  41. Meckel S, Reisinger C, Bremerich J, Damm D, Wolbers M, Engelter S, et al. Cerebral venous thrombosis: diagnostic accuracy of combined, dynamic and static, contrast-enhanced 4D MR venography. AJNR Am J Neuroradiol. 2010;31(3):527–35.

    Article  CAS  PubMed  Google Scholar 

  42. Lee VH, Brown Jr RD, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology. 2006;67(10):1809–12.

    Article  PubMed  Google Scholar 

  43. Schievink WI, Roiter V. Epidemiology of cervical artery dissection. Front Neurol Neurosci. 2005;20:12–5.

    PubMed  Google Scholar 

  44. Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(10):3155–74.

    Article  CAS  PubMed  Google Scholar 

  45. Lyrer PA, Brandt T, Metso TM, Metso AJ, Kloss M, Debette S, et al. Clinical import of Horner syndrome in internal carotid and vertebral artery dissection. Neurology. 2014;82(18):1653–9.

    Article  PubMed  Google Scholar 

  46. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology. 2011;77(12):1174–81.

    Article  CAS  PubMed  Google Scholar 

  47. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Cervical artery dissection—clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 2003;250(10):1179–84.

    Article  PubMed  Google Scholar 

  48. Hosoya T, Nagahata M, Yamaguchi K. Prevalence of vertebral artery dissection in Wallenberg syndrome: neuroradiological analysis of 93 patients in the Tohoku District, Japan. Radiat Med. 1996;14(5):241–6.

    CAS  PubMed  Google Scholar 

  49. Fukuoka T, Takeda H, Dembo T, Nagoya H, Kato Y, Deguchi I, et al. Clinical review of 37 patients with medullary infarction. J Stroke Cerebrovasc Dis. 2012;21(7):594–9.

    Article  PubMed  Google Scholar 

  50. Paciaroni M, Caso V, Agnelli G. Magnetic resonance imaging, magnetic resonance and catheter angiography for diagnosis of cervical artery dissection. Front Neurol Neurosci. 2005;20:102–18.

    PubMed  Google Scholar 

  51. Coppenrath EM, Lummel N, Linn J, Lenz O, Habs M, Nikolaou K, et al. Time-of-flight angiography: a viable alternative to contrast-enhanced MR angiography and fat-suppressed T1w images for the diagnosis of cervical artery dissection? Eur Radiol. 2013;23(10):2784–92.

    Article  CAS  PubMed  Google Scholar 

  52. Felber S, Auer A, Schmidauer C, Waldenberger P, Aichner F. Magnetic resonance angiography and magnetic resonance tomography in dissection of the vertebral artery. Radiologe. 1996;36(11):872–83.

    Article  CAS  PubMed  Google Scholar 

  53. Vertinsky AT, Schwartz NE, Fischbein NJ, Rosenberg J, Albers GW, Zaharchuk G. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 2008;29(9):1753–60.

    Article  CAS  PubMed  Google Scholar 

  54. Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, et al. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke. 2009;40(11):3646–78.

    Article  PubMed  Google Scholar 

  55. Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol. 2012;11(10):906–17.

    Article  PubMed  Google Scholar 

  56. Sattar A, Manousakis G, Jensen MB. Systematic review of reversible cerebral vasoconstriction syndrome. Expert Rev Cardiovasc Ther. 2010;8(10):1417–21.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Gerretsen P, Kern RZ. Reversible cerebral vasoconstriction syndrome: a thunderclap headache-associated condition. Curr Neurol Neurosci Rep. 2009;9(2):108–14.

    Article  PubMed  Google Scholar 

  58. Pizzanelli C, Catarsi E, Pelliccia V, Cosottini M, Pesaresi I, Puglioli M, et al. Primary angiitis of the central nervous system: report of eight cases from a single Italian center. J Neurol Sci. 2011;307(1–2):69–73.

    Article  PubMed  Google Scholar 

  59. Birnbaum J, Hellmann DB. Primary angiitis of the central nervous system. Arch Neurol. 2009;66(6):704–9.

    Article  PubMed  Google Scholar 

  60. Muehlschlegel S, Kursun O, Topcuoglu MA, Fok J, Singhal AB. Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol. 2013;70(10):1254–60.

    PubMed  Google Scholar 

  61. Mathon B, Ducros A, Bresson D, Herbrecht A, Mirone G, Houdart E, et al. Subarachnoid and intra-cerebral hemorrhage in young adults: rare and underdiagnosed. Rev Neurol (Paris). 2014;170(2):110–8.

    Article  CAS  Google Scholar 

  62. Ansari SA, Rath TJ, Gandhi D. Reversible cerebral vasoconstriction syndromes presenting with subarachnoid hemorrhage: a case series. J Neurointerv Surg. 2011;3(3):272–8.

    Article  PubMed  Google Scholar 

  63. Marder CP, Donohue MM, Weinstein JR, Fink KR. Multimodal imaging of reversible cerebral vasoconstriction syndrome: a series of 6 cases. AJNR Am J Neuroradiol. 2012;33(7):1403–10.

    Article  CAS  PubMed  Google Scholar 

  64. Ducros A, Boukobza M, Porcher R, Sarov M, Valade D, Bousser MG. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain. 2007;130(Pt 12):3091–101.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Sabareesh K. Natarajan and Dr. Ashish Sonig each declares no potential conflicts of interest.

Dr. Maxim Mokin reports a grant from Toshiba.

Dr. Elad I. Levy reports other from Intratech Medical Ltd, other from Blockade Medical LLC, other from Abbott, outside the submitted work; and Principal investigator: Covidien US SWIFT PRIME Trials (for stent retrievers in acute ischemic stroke).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Sabareesh K. Natarajan, Maxim Mokin, Ashish Sonig & Elad I. Levy

  2. Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, NY, USA

    Sabareesh K. Natarajan, Maxim Mokin, Ashish Sonig & Elad I. Levy

  3. Departments of Neurology and Neurosurgery, University of South Florida College of Medicine, Tampa, FL, USA

    Maxim Mokin

  4. Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    Elad I. Levy

  5. Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA

    Elad I. Levy

Authors
  1. Sabareesh K. Natarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxim Mokin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashish Sonig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elad I. Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elad I. Levy.

Additional information

This article is part of the Topical Collection on Imaging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Natarajan, S.K., Mokin, M., Sonig, A. et al. Neuroimaging of Headaches Associated with Vascular Disorders. Curr Pain Headache Rep 19, 16 (2015). https://doi.org/10.1007/s11916-015-0489-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-015-0489-9

Keywords

Search

Navigation