Before getting onto vascular headache, a word of warning.
First or worst ever headache, or totally different to others you've had?
This is not ideally a self help situation.
There are lots of really serious conditions you could have, so I advise you to go to an emergency room or doctor, if this is possible.
Are your recurrent headaches vascular headache, or some other type?
Your headaches can be more effectively treated if you first sort out what type of headache they are.
You can test yourself for two major causes, by pressing on the Temporal artery in front of your ear, early in the course of a headache attack.
If your headaches start during the day, you need to do the following test within one hour of the onset. It is not useful if you wake up with the headache, or are unable to do the test in the first hour.
After this time, muscles have tightened up and become tender, whatever started the headache. Your muscles then make a major contribution to the pain, and pressing on the artery may not help.
It may help, indicating that you have a vascular headache, but if it doesn't help now, it remains uncertain. It is always worth trying at any stage.
Practice this when you are free of a headache, so that you will be able to do it confidently when a headache starts.
Lay your fingers flat on the cheek in front of your ear, then open and close your mouth repeatedly. Just in front of the ear you are feeling the rounded top of the lower jawbone, moving forwards and backwards as you open and close respectively.
Gently place two finger tips on the face immediately in front of your ear, on this bone or between it and the ear, (or just above here.) Feel around until you find your pulse here
Alternatively, with the tip of your index finger follow your cheek bone around to your ear. Gently feel around just in front of your ear. The pulse will be just above the bone, just in front of the ear.
This is called the “superficial temporal artery.”
At the start of a headache, press very firmly exactly on this pulse on each side of the head, so as to squash both arteries flat.
Hold them flattened for about 30 seconds and note whether the headache is altered. It may shift or increase or decrease. Let the pressure off the arteries, but do not shift your fingers. Note what happens to the headache then.
Vascular headaches, including migraine will be relieved during the pressure, only to return when it is let off.
In this type of headache, the artery widens and becomes tender. The pulsing flow of blood up the artery, causes the pain (which may be throbbing type.) By squashing the artery, you have stopped the flow.
Scalp Muscle tension headaches will be unchanged or aggravated during the pressure. Occasionally someone says that there is no change while the pressure is applied, but then says that the headache has improved after it is released. It is fairly hard to concentrate on how the headache is feeling, when one is distracted by the firm pressure over the artery.
If the pressure on the artery is maintained just long enough to make the above observations, a vascular headache will return pretty quickly after its release.
To treat the attack, continue to pressure for 5 minutes by the clock. The headache will most likely stay away for 20 minutes or so, when the same procedure can be repeated. I have only once treated a patient this way myself, and after an hour the attack had burnt it self out.
This is pretty hard on one's fingers. Start with index finger, then when that tires move to the middle and finally to the ring finger. By this time the pointer will have recovered enough to take its turn again.
Twenty minutes later your hands will hopefully have recovered enough to go over the same punishment all over again.
Official diagnostic requirements for "migraine" are this sort of thing...
1. At least 5 attacks
2. Lasting 4-72 hours without successful treatment
3. With two or more (not all) of...
.. a. one sided
.. b. throbbing
.. c. moderate or severe pain
.. d. disabling and aggravated by activity
.. e. with nausea, vomiting or dislike of light, noise
4. Not daily, and not due to some other condition (sinus etc.)
Throbbing doesn't equate with primary vascular disorder, as anyone with a boil can confirm. A person can have "migraine" headaches without feeling throbbing.
I think that the modern move² away from thinking of migraine as a vascular mediated condition, is because people have not been tested as detailed on this page.
"Migraine" as defined above, and vascular headache, certainly largely overlap, but I suspect some "migraine" is a different condition. The term is often used for any severe headache.
This does make the diagnosis beyond doubt - it is very distinctive.
It is really important to distinguish migraine aura from having a TCIA due to clots or bleeds in arteries leading to the brain.
If you think you may have had a TCIA, urgent medical attention is required.
The critical thing is the onset of the symptoms, each here developing gradually over five or more minutes. The onset of a TCIA is quite sudden.
Both conditions can be associated with headache, are short lived and recover completely.
Migraine aura doesn't include muscular weakness. Eyesight is most frequently affected, then feeling in face or limbs and sometimes balance or speech.
Some people get this aura without a headache, called "migraine equivalent" or "silent migraine."
This condition is very serious as it can suddenly lead to blindness of the eye on the affected side. This is a vascular headache with blockage of the blood vessel.
One clue to this is pain on chewing, as is generally feeling unwell.
The artery is inflamed so will be swollen and tender, but unlike in migraine will not be pulsing. In migraine the artery is tender and its pulsation is more obvious than usual.
The most common reason by far, for tenderness here without arterial pulsation, is that the Temporalis muscle is tight and tender, rather than anything to do with the artery.
In temporal arteritis one may have weight loss, malaise, weakness and fever.
If you suspect temporal arteritis, get medical advice today. I had one patient lose the sight in an eye a day or so after I put them on cortisone, while waiting to see the eye doctor. I didn't realize at that time, how big a dose of cortisone was needed.
People generally need cortisone treatment for 3 to 5 years for this condition. It is serious.
People with hypertension do get more ordinary headaches than normotensive individuals.
The specific headache of severe hypertension is seldom seen these days. It is a dull headache at the very back of one's head, on awakening, relieved soon after first arising.
This is part of hypertensive encephalopathy, and resolves very rapidly when treatment is started, even before office blood pressure measurements drop.
Migraine and hypertension can both be manifestations of food intolerance. People tend to grow out of migraine and grow into hypertension, both with the same underlying cause.
Cervicogenic headache and sphenoid sinusitis are other headaches here at the back of our head.
A very well researched naturopathy site, www.healthy-alternative-solutions.com, covers this well.
80% of adult migraine sufferers have food intolerance. This is immune based reactions, to foods most commonly eaten. Amine containing foods can also precipitate attacks.
A hypoallergenic, stone age diet, may help now.
If someone has a recent increase in the frequency of their migraines, I generally expect to find they have put their neck out.
A little known cause of headaches is sensitivity to alternating electromagnetic fields¹<span style='font-size: 50%'>.
It is worth shifting bedside clock-radios and unplugging electric blankets at the wall socket rather than just turning the blanket off with its switch, etc, just as an experiment.
Copper deficiency may contribute to this last problem.
I've a relative who would dearly love to be able to drink red wine, but has to stick to whites. If something regularly gives you headaches, it makes sense to avoid it.
Some researchers in Denmark just published³ a cautionary tale on this, having mostly failed to precipitate attacks in the laboratory using a couple of such triggers.
Dr Hougaard was reported in Medscape as saying
"Migraine patients are usually advised to identify triggers and try and avoid them. Our research suggests that this may be limiting people's lives and causing unnecessary stress in trying to avoid a wide range of factors which may turn out not to be triggers after all.
Of course patients need to try to identify triggers but they need to establish that they are true triggers before cutting them out of their lives. So I would advise that they allow several exposures before defining a trigger. Many people avoid a whole array of factors such as red wine, chocolate, cheese, coffee, exercise, and sunlight. This can make life very difficult and it might not be necessary."
A local allergy specialist in Melbourne, had a volunteer give herself a migraine in hospital to allow study of the early changes in platelet aggregation at the start of a migraine. She needed to drink from memory a pint and a half of cows milk to bring on an attack, an amount she would never drink at home. Dose can matter, unlike some immediate allergies such as to peanut where traces are enough.
2. http://www.ncbi.nlm.nih.gov/pubmed/21352215 A review by Dr. Shevel (Headache Clinic, Johannesburg, South Africa.) in the journal Headache. 2011 Mar;51(3):409-17
Titled "The extracranial vascular theory of migraine--a great story confirmed by the facts." -supporting my ideas above.
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Transient cerebral ischaemic attack, or mini stroke is often abbreviated using the acronym, TCIA