Painful scalp arteries in migraine

Abstract

Previous studies suggest a role of scalp perivascular structures in at least a substantial number of migraineurs. This study aimed to evaluate the presence of pressure-painful scalp arteries in patients with migraine. Pressure-painful points on scalp arteries were searched for in 100 consecutive patients affected with migraine, 84 females (F) and 16 males (M), 83 without aura (70 F) and 17 with aura (14 F), and in 30 healthy matched subjects. The examined arteries were, bilaterally, the superficial temporal and its frontal branch, the zygomatico-orbital, the occipital and the posterior auricular. We examined 75 patients interictally: 60 (80.0%) reported one or more (mean per subject 3.7 ± 1.9) pressure-painful arteries and 15 (20.0%) reported none. In the 30 controls, pressure-painful arteries were present in only nine (30.0%, mean per subject 1.3 ± 0.7), with highly significant differences (p < 0.001). During a migraine attack, of the 51 patients examined, 45 (88.2%, 38F) reported one or more (mean 3.8 ± 2.1) pressure-painful arteries and six (11.8%) reported none. Both when during an attack and interictally, the arteries most frequently involved were the occipital, the frontal branch, and the temporal. Scalp arteries are frequently painful to pressure in migraineurs, especially in females, both during headache and interictally. Painful arteries suggest hypersensitivity of periarterial nociceptive afferents, which is perhaps due to the local presence of endogenous algogenic products, as suggested by our previous studies.

TRPV1, CGRP and SP in scalp arteries of patients suffering from chronic migraine

“…Although a role of central mechanisms in migraine is strongly supported by several data,4 the sharing of a peripheral mechanism mainly acting on scalp arteries is also reliable 6. Pressure painful scalp arteries are present in a large percentage of migrainous participants, during and in the interval between the migraine attacks 27. This suggests a susceptibility to pain of such structures in migraine.…”

Unilateral Headache Status after Intra-Aortic Balloon Pump Placement

“…This close proximity to the left carotid artery, the authors hypothesize, may also incur increased pressure and volume displacement during inflation, consequently raising diastolic pressures in the external and internal carotid arteries. Vasodilation of the superficial temporal artery, a major branch of external carotid artery, is a common cause of migraine, which may be a cause of severe unilateral headache in the presented patient as evidenced by the dramatic resolution of symptoms following IABP removal [ 19 ].…”

Pressure-painful scalp arteries in children and adolescents suffering from migraine

“…Painful arteries suggest hypersensitivity of periarterial nociceptive afferents, perhaps due to the local presence of endogenous algogenic products. Dilution of these products could explain the effect of periarterial injection of simple saline (8). Alternatively, a local hypersensitivity of pain receptors located in the periarterial afferent fibres might be involved.…”

“…According to our protocol for routine examinations of headache patients, each patient was examined to detect pressure-painful points on scalp arteries. We used the same procedures outlined in the Cianchetti et al study on adults with migraine and followed the protocol described in that study (8). In brief, the examination included the following arteries: the superficial temporal artery, its frontal branch, the zygomatico-orbital artery, and the occipital and posterior auricular arteries, all examined bilaterally.…”

“…We recently reported data in favour of a role of neurovascular scalp structures in some patients with migraine (4)(5)(6)(7). These included the presence of tender points on one or more scalp arteries in adult migraine sufferers (8).…”