Cerebral Venous Thrombosis with Migraine-Like Headache and the Trigeminovascular System.

Fábio A Nascimento,Pedro A Kowacs,Vanessa Rizelio,Marília Grando Sória

doi:10.1155/2016/2059749

Abstract

Cerebral venous thrombosis- (CVT-) associated headache is considered a secondary headache, commonly presenting as intracranial hypertension headache in association with seizures and/or neurological signs. However, it can occasionally mimic migraine. We report a patient presenting with a migraine-like, CVT-related headache refractory to several medications but intravenous dihydroergotamine (DHE). The response to DHE, which is considered to be an antimigraine medication, in addition to the neurovascular nature of migraine, points out to a probable similarity between CVT-headache and migraine. Based on experimental studies, we discuss this similarity and hypothesize a trigeminovascular role in the genesis of CVT-associated headache.

Highlights

Headaches attributed to cerebral venous thrombosis (CVT) (ICHD-III 6.6) are those temporally related to a diagnosis of CVT, confirmed by neuroimaging, and most commonly present as “diffuse, progressive, intense headaches, associated with other signs of intracranial hypertension” [1]
We report a patient presenting with migraine-like headache in the context of CVT and frontal infarction
Her headache can be readily diagnosed as being due to CVT [1], the possibility of the headache being secondary to the frontal infarction should be acknowledged

Summary

Introduction

Headaches attributed to cerebral venous thrombosis (CVT) (ICHD-III 6.6) are those temporally related to a diagnosis of CVT, confirmed by neuroimaging, and most commonly present as “diffuse, progressive, intense headaches, associated with other signs of intracranial hypertension” [1]. The CVT involved thrombosis of the superior sagittal sinus (SSS) The response of this CVT-related headache to intravenous DHE, in addition to the fact that the headache featured migraine characteristics, highlights pathophysiological similarities between this secondary headache and migraine. This good response resembles, in some aspects, the DHE effect in the experimental cat model whose SSS was stimulated [2]

Case Report

Discussion