Objective
We hypothesize that following a sudden decrease in cerebral blood flow velocity (CBFV) in adolescents at faint, rapid hyperemic pulsatile CBFV occurs upon the return to the supine position, and is associated with post-syncopal headache.
Study design
This case-control study involved 16 adolescent subjects with history of fainting and headaches. We induced faint during 70° tilt-table testing and measured mean arterial pressure (MAP), heart rate (HR), end-tidal CO2, and CBFV. Fifteen control subjects were similarly evaluated with a tilt but did not faint, and comparisons with fainters were made at equivalent defined time points.
Results
Baseline values were similar between groups. Upon fainting, MAP decreased 49% in fainters vs. 6% in controls (P<0.001). HR decreased 15% in fainters and increased 35% in controls (P<0.001). In fainters, cerebrovascular critical closing pressure increased markedly resulting in reduced diastolic (-66%) and mean CBFV (-46%) at faint; systolic CBFV was similar to controls. Pulsatile CBFV (systolic – diastolic CBFV) increased 38% in fainters, driving flow-mediated dilation of cerebral vessels. Returning to supine, fainters’ CBFV exhibited increased systolic and decreased diastolic flows compared with controls (P<0.02).
Conclusion
Increased pulsatile CBFV during and following faint may cause post-syncopal cerebral vasodilation and headache.