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Abstract
The aim of the present work was to study the middle cerebral artery blood flow velocities and vasoreactivity in cluster headache patients during spontaneous attacks and after administration of 100 % oxygen.
The material of the present work consisted of 24 patients with cluster and migraine headaches presented to the neurology department at El-Hadara University Hospital and 12 healthy controls. They were divided into 2 groups according to diagnosis. Group I consisted of 12 patients complaining of cluster headache, Group II consisted of 12 patients complaining of unilateral migraine and 12 healthy volunteers.
All patients were subjected to questionnaire for analysis of headache, and headache pain severity scale, thorough medical and neurological examination, laboratory investigations and neuroimaging when needed, and Transcranial Doppler examination to examine the peak systolic velocity, the mean flow velocity, and the end diastolic velocity.
Cerebrovascular reactivity was tested in terms of the breath holding index, which is the simplest way of challenging the vasomotor reactivity. This index was calculated using the mean flow velocities obtained by TCD before breath-holding (baseline) and after breath holding (at the end of 4 seconds of breathing after 30 seconds of breath-holding) and another reading was taken using 100% oxygen inhalation at 10 liter/second.
Both groups were studied clinically and by Transcranial Doppler ultrasound. The study revealed the following:
1. Assessment of the headache severity using the headache pain severity scale showed that the cluster headache is more painful than the migraine headache, which reached a statistical significance.
2. During cluster periods, the baseline mean middle cerebral artery blood flow velocities were higher on the symptomatic side compared to the non-symptomatic side; however, the difference did not reach statistical significance.
3. The peak flow velocity of the cluster group was less than that of the migraine group; however, this difference did not reach statistical significance.
4. The cluster group showed decreased mean flow velocity of the MCA compared to the migraine group after 30 sec breath holding readings (BH), but the difference did not reach statistical significance.
5. After oxygen administration (O2), the cluster group showed decreased MCA mean flow velocity compared to the migraine group, but the difference did not reach statistical significance.
6. After oxygen administration (O2) following breath holding for 30 seconds, the cluster group showed decreased mean flow velocity compared to the migraine group, which was statistically significant.