title: Migraine aggravation caused by cephalic venous congestion.
abstract: BACKGROUND
  Cerebral venous distension is thought by some to serve as a source of migraine pain. Previous investigators have tried to modify pain intensity by induction of additional venous congestion via compression of both internal jugular veins (Queckenstedt's maneuver). The magnitude of blood flow within the internal jugular veins depends markedly on body position, and inconsistencies in positioning may have influenced their results.
  
  
  OBJECTIVE
  To investigate the effect of Queckenstedt's maneuver, performed both in the upright and in the supine body position, in migraineurs during an acute attack.
  
  
  METHODS
  Twenty-five patients (18 women, 7 men; mean age +/- SD, 35.4 +/- 13.3 years) with International Headache Society-defined migraine without aura were evaluated. Queckenstedt's maneuver was performed in both body positions during an acute migraine attack, involving constant application of manual pressure to both internal jugular veins for 30 seconds. Headache intensity was rated before, during, and after Queckenstedt's maneuver on a scale extending from 1 (mild) to 10 (intolerable).
  
  
  RESULTS
  Seventeen patients (68%) reported an increase of headache intensity in the supine position during Queckenstedt's maneuver. In the sitting position, pain increase was observed only in 6 patients (24%). The magnitude of pain increase was significantly greater in the supine position compared to the upright position (P=.02).
  
  
  CONCLUSIONS
  Our results support a role for cerebral venous congestion in the generation of migraine pain and suggest body position may influence the clinical expression of that process.
authors.affiliation: Department of Neurology, University Hospital Charité, Humboldt University, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Doepp
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Schreiber
authors.forename: Jens P
authors.initials: JP
authors.lastname: Dreier
authors.forename: Karl M
authors.initials: KM
authors.lastname: Einhäupl
authors.forename: José M
authors.initials: JM
authors.lastname: Valdueza
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D020326:Migraine without Aura / Q000145:classification / Q000503:physiopathology*; D010147:Pain Measurement; D011312:Pressure; D013484:Supination