Breath holding index in episodic primary headaches
Abstract
Background/Aim. Examination of cerebrovascular reactivity in patients with primary headaches is focused mainly on migraine, while the smaller number of studies deals with tension-type and cluster headache, or comparison of cerebral haemodynamic in migraine and tension-type headache (TTH). In this study, we hypothesized that cerebrovascular reactivity differs among different types of episodic primary headaches. In order to prove that we aimed to compare the interictal cerebrovascular reactivity in patients with the episodic form of the three most common types of primary headaches using the breath holding test. Methods. Examination was performed in 243 patients, 100 migraineurs with aura (group I), 70 migraineurs without aura (group II), 38 patients with episodic tension-type headache (group III), 35 patients with episodic form of cluster headache (group IV) and 35 healthy controls (group V). The Doppler instrument was used for transcranial doppler (TCD) sonography and breath-holding test performance. Blood flow mean velocities (MV), pulsatility indices (PI) and breath-holding index (BHI) for middle cerebral artery among these groups were analyzed.
Results. The mean velocities and pulsatility indices were not different in 4 groups of headache patients and controls. The BHI was found to be significantly greater in the migraineurs with aura (1.668 ± 0.269) compared with the patients with migraineurs without aura (1.411 ± 0.358, p = 0.005), tension type headache (1.401 ± 0.428, p = 0.035), cluster headache (1.203 ± 0.311, p < 0.01) and controls (1.195 ± 0.269, p < 0.01) showing an exaggerated reactivity to hypercapnia in patients with migraine with aura. Conclusion. In conclusion, our finding support the literature data that increased cerebrovascular reactivity is a feature of migraine with aura. Result of unchanged cerebrovascular reactivity in migraine without aura, cluster headache and tension-type headache is expected, still, it is possible that in future, using different technique, we will be able to put more light on vascular changes that are following different headache disorders.
References
Reference
Shevel E. The extracranial vascular theory of migraine-a great story conirmed by the facts. Headache 2011; 3(51): 409–17.
Noseda R, Burstein R. Migraine pathopysiology: Anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain 2013; 154(Suppl 1): S44–53.
Charles A. Migraine: A brain state. Curr Opin Neurol 2013; 3(26): 235–9.
May A. Cluster headache: pathogenesis, diagnosis, and man-agement. Lancet 2005; 366(9488): 843–55.
Lee MJ, Chu MK, Choi H, Choi HA, Lee C, Chung CS. Longitu-dinal changes in cerebral blood flow velocities in different clinical courses of migraine. Cephalalgia 2016; pii: 0333102416658715.
Silvestrini M, Baruffaldi R, Bartolini M, Vernieri F, Lanciotti C, Matteis M, et al. Basilar and middle cerebral artery reactivity in patients with migraine. Headache 2004; 44(29): 29–34.
Rosengarten B, Sperner J, Görgen-Pauly U, Kaps M. Cere-brovascular reactivity in adolescents with migraine and tension-type headache during headache-free interval and attack. Headache 2003; 43(5): 458–63.
Piccini P, Pavese N, Palombo C, Pittella G, Distante A, Bonuccelli U. Transcranial Doppler ultrasound in migraine and tension-type headache after apomorphine administration: double-blind crossover versus placebo study. Cephalalgia 1995; 15(5): 399–403.
Arjona A, Perula de Torres LA, Espino R. Mean velocity and pulsatile index in primary headaches. Rev Neurol 2002; 34(4): 314–6. (Spanish)
Heckmann JG, Mück-Weymann M, Katalinic A, Hilz MJ, Claus D, Neundörfer B. Transcranial Doppler exercise test in patients with chronic tension headache. Nervenarzt 1998; 69(2): 131–6. (German)
Wallasch TM. Transcranial Doppler ultrasonic features in chronic tension-type headache. Cephalalgia 1992; 12(6): 385–6.
Dora B, Balkan S. Exaggerated interictal cerebrovascular reac-tivity but normal blood flow velocities in migraine without aura. Cephalalgia 2002; 22(4): 288–90.
Akgün H, Taşdemir S, Ulaş ÜH, Alay S, Çetiz A, Yücel M, et al. Reduced breath holding index in patients with chronic mi-graine. Acta Neurol Belg 2015; 115(3): 323–7.
Arjona A, de Torres LA, Serrano-Castro PJ, Guardado-Santervas PL, Olivares J, Rubí-Callejon J. A transcranial doppler study in interictal migraine and tension-type headache. J. Clin Ultrasound 2007; 35: 372–5.
Fiermonte G, Pierelli F, Pauri F, Cosentino FI, Soccorsi R, Giacomini P. Cerebrovascular CO2 reactivity in migraine with aura and without aura. A transcranial Doppler study. Acta Neurol Scand 1995; 92(2): 166–916.
Totaro R, De Matteis G, Marini C, Prencipe M. Cerebral blood flow in migraine with aura: a transcranial Doppler sonography study. Headache 1992; 32(9): 446–51.
Fiermonte G, Annulli A, Pierelli F. Transcranial Doppler evalua-tion of cerebral hemodynamics in migraineurs during prophy-lactic treatment with flunarizine. Cephalalgia 1999; 19(5): 492–6.
Micieli G, Tassorelli C, Bosone D, Cavallini A, Bellantonio P, Rossi F, et al. Increased cerebral blood flow velocity induced by cold pressor test in migraine: a possible basis for pathogenesis? Cephalalgia 1995; 15(6): 494–8.
Tahoon SA, Hamdy MM, Saad Allah HM, El-Bassiouny ME. Transcranial Doppler study in patients with cluster headache. Alexandria J Med 2013; 49(1): 207–10.
Headache Classification Committee of the International Headache Society, IHS. The International classification of headache disorders. 3rd ed. (beta version). Cephalalgia 2013; 33(9): 629–808.
Markus HS, Harrison MJ. Estimation of cerebrovascular reac-tivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke 1992; 23(5): 668–73.
Silvestrini M, Troisi E, Matteis M, Cupini LM, Caltagirone C. Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis. Stroke 1996; 27(11): 1970–3.
Bäcker M, Sander D, Hammes MG, Funke D, Deppe M, Conrad B, et al. Altered cerebrovascular response pattern in interictal migraine during visual stimulation. Cephalalgia 2001; 21(5): 611–6.
Manzoni GC, Torelli P. Migraine with and without aura: a single entity? Neurol Sci 2008; 29 Suppl 1: S40–3.
Zaletel M, Strucl M, Bajrović FF, Pogacnik T. Coupling between visual evoked cerebral blood flow velocity responses and visual evoked potentials in migraneurs. Cephalalgia 2005; 25(8): 567–74.
Vernieri F, Tibuzzi F, Pasqualetti P, Altamura C, Palazzo P, Rossini PM, et al. Increased cerebral vasomotor reactivity in migraine with aura: an autoregulation disorder? A transcranial Doppler and near-infrared spectroscopy study. Cephalalgia 2008; 28(7): 689–95.
Fabjan A, Zaletel M, Žvan B. Is There a Persistent Dysfunction of Neurovascular Coupling in Migraine?. Bio Med Resh Int 2015; 2015: 574186.
Lecrux C, Hamel E. The neurovascular unit in brain function and disease. Acta Physiol (Oxf) 2011; 203(1): 47–59.
Sacco S, Ripa P, Grassi D, Pistoia F, Ornello R, Carolei A, et al. Peripheral vascular dysfunction in migraine: A review. J Head-ache Pain 2013; 14(1): 80.
Akerman S, Holland PR, Lasalandra MP, Goadsby PJ. Oxygen inhibits neuronal activation in the trigeminocervical complex after stimulation of trigeminal autonomic reflex, but not during direct dural activation of trigeminal afferents. Headache 2009; 49(8): 1131–43.