Blood Pool Scintigraphy of the Skull in Relation to Head-Down Tilt Provocation in Patients With Chronic Tension-Type Headache and Controls

• Published in: Headache Vol. 44; no. 3; pp. 223 - 229
• Main Authors: Hannerz, Jan, Schnell, P.-O., Larsson, Stig, Jacobsson, Hans
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148 , USA Blackwell Science Inc 01.03.2004; Blackwell
• Subjects: Adult; Biological and medical sciences; blood pool scintigraphy; Blood Volume; Chronic Disease; chronic tension-type headache; Female; Gated Blood-Pool Imaging; Head - blood supply; head-down tilt; Head-Down Tilt - physiology; Humans; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Neurology; Tension-Type Headache - diagnostic imaging; Tension-Type Headache - physiopathology; Vascular diseases and vascular malformations of the nervous system; Human; Nervous system diseases; Head; head-down tilt; chronic tension-type headache; Check; Scintigraphy; Blood; Cerebral disorder; Tension headache; Chronic; Central nervous system disease; Skull; blood pool scintigraphy; Cerebrovascular disease
• DOI: 10.1111/j.1526-4610.2004.04051.x
• ISSN: 0017-8748

Objective.—To investigate the mechanisms behind the increase of chronic tension‐type headache during head‐down tilt. Background.—The pathophysiology of chronic tension‐type headache is unknown. Design and Methods.—Ten patients suffering from chronic tension‐type headache and 10 age‐ and sex‐matched controls were studied with respect to pain intensity and alterations in cranial blood volume using planar scintigraphy and radiolabeled autologous erythrocytes before, during, and after head‐down tilt, a procedure known to increase chronic tension‐type headache. Results.—Four of 8 patients with chronic tension‐type headache studied had increased cerebrospinal fluid pressure. During head‐down tilt, the pain increased significantly in the group with chronic tension‐type headache (P < .001) while the procedure did not cause headache in the controls. Blood volume significantly increased extracranially and decreased intracranially in both groups during head‐down tilt. The extracranial nasal blood volume was significantly related to the pain experienced by the patients with chronic tension‐type headache before and during head‐down tilt. Conclusions.—Although the changes in blood volume and, presumably, the increase of intracranial pressure were similar in the patients with chronic tension‐type headache and the controls, only the patients experienced pain and pain increase during head‐down tilt. This indicates that the pre‐head‐down tilt conditions must be different in the 2 groups and should be related to increased cerebrospinal fluid pressure/intracranial venous pressure in patients with chronic tension‐type headache compared with controls. A difference in central mechanisms may, however, also be of importance for the difference in headache provocation in the 2 groups during head‐down tilt.