Cerebral venous hemodynamics and venous blood flow reactivity in patients with migraine

Abstract

Introduction. Headache is currently one of the most common complaints in various pathological conditions. At the present level, the use of transcranial duplex scanning (TDS) in the diagnosis of various types of headache is relevant. Recently, a sufficiently large number of works have been published on the study of cerebral hemodynamic disorders in patients with migraine with and without aura, in the interictal period and during an attack. The ample data support the vascular hypothesis of migraine pathogenesis. Studies of venous cerebral hemodynamics have also been conducted in patients with migraine. The relationship between the severity of venous disorders and the state of vascular tone was revealed. Cerebrovascular reactivity (CVR) is considered as an integral indicator of the adaptive capabilities of the cerebral circulatory system. The use of TDS to assess CVR is informative in patients with migraine. The aim of the study was to assess the state of the cerebral venous hemodynamics and regulation cerebral venous blood flow in patients with migraine. Materials and methods. We performed clinical Doppler examination of 124 young patients (55 men, 69 women) with migraine without aura (group 1 – 63 patients), migraine with aura (group 2 – 61 patients). The TDS method was used to study indicators maximum linear speed blood flow (Vmax) in the supraocular (SOV) and vertebral (VV) veins, basal veins of Rosenthal (BV), direct sinus (DS), as well as reactivity coefficients in DS and BV using hypercapnic, orthostatic, antiorthostatic loads. Results. Patients of the 1st group were characterized by hyporeactivity in DS and BV to hypercapnic load, as a sign of primary venous angiodystonia. Also hyperreactivity of these patients to antiorthostatic load in PS and BV was revealed, as an indicator of dysfunction of the neurogenic regulation circuit. The patients of the 2nd group showed a combined hyperreactivity in DS and BV to hypercapnic and antiorthostatic loads, as a sign of dysfunction of the neurogenic circuit of vascular regulation. Conclusions. Cerebral venous hemodynamic changes in patients with migraine in the interictal period are manifested as disorders of cerebral venous blood flow in the superocular veins, basal veins of Rosenthal and direct sinus, more pronounced in the migraine with aura group. Patients with migraine without aura are characterized by hyporeactivity in DS and BV to hypercapnic load and hyperreactivity to antiorthostatic load in PS and BV. In patients with migraine with aura, hyperreactivity in PS and BV to hypercapnic and antiorthostatic loads is observed. The use of Doppler study of cerebral venous hemodynamics and reactivity of venous cerebral blood flow makes it possible to clarify the pathogenetic mechanisms of a migraine attack and helps to optimize the treatment of patients with migraine, taking into account the state of cerebral vascular regulation.