title: Cerebrovascular reactivity during the Valsalva maneuver in migraine, tension-type headache and medication overuse headache.
abstract: The aim of this study was to investigate, by means of transcranial Doppler ultrasound (TCD), cerebrovascular reactivity during the Valsalva maneuver (VM) during the headache-free interval in patients with migraine (M), migraine plus tension-type headache (M+TTH), and migraine plus medication overuse headache (M+MOH). A total of 114 patients (n=60 M, n=38 M+TTH, n=16 M+MOH) and n=60 controls were investigated; diagnoses were made according to the International Headache Society criteria. All subjects underwent TCD monitoring and, simultaneously, non-invasive assessment of arterial blood pressure and end-tidal CO2. Two indices were determined: the cerebrovascular Valsalva ratio (CVR) was calculated as the maximum end-diastolic flow velocity acceleration during the late straining phase of the VM [cm/s2] and the centroperipheral Valsalva ratio (CPVR) was defined as the quotient of CVR to the concomitant arterial blood pressure acceleration [cm/mmHg x s]. The dynamic cerebrovascular autoregulatory response to the VM, measured as CVR, was increased in patients with M and M+TTH compared to age-matched healthy subjects. By contrast, CPVR (i.e. the quotient of the cerebrovascular to the peripheral autonomic response), was increased in M patients compared to healthy subjects and all other headache conditions tested. Cerebrovascular autoregulatory response during the VM was increased in M patients compared to age-matched normal healthy subjects, indicating a disturbed autonomic control of cerebral vasoreactivity. The CPVR seems to be a sensitive parameter for distinguishing between M patients and M+TTH or M+MOH patients.
authors.affiliation: MEDAS Ostschweiz, Interdisciplinary Medicine, St. Gallen, Switzerland. tomwallasch@aol.com
authors.forename: T M
authors.initials: TM
authors.lastname: Wallasch
authors.forename: P
authors.initials: P
authors.lastname: Beckmann
authors.forename: P
authors.initials: P
authors.lastname: Kropp
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000097:blood; D002561:Cerebrovascular Disorders / Q000503:physiopathology*; D005260:Female; D051271:Headache Disorders, Secondary / Q000503:physiopathology*; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000503:physiopathology*; D008955:Models, Cardiovascular; D018781:Tension-Type Headache / Q000503:physiopathology*; D014636:Valsalva Maneuver / Q000502:physiology*; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide