Symptoms of Vascular Headache Triggered by Intracranial Hypertension

SYNOPSIS

A 23-year-old male presented with features of vascular headache (unilateral throbbing pain of brief duration and ocular site). Ipsilateral tingling and hypalgesia were noted over part of the face during the headache. Papilledema was prominent. Increased intracranial pressure (ICP) and hydrocephalus were caused by aqueductal stenosis as noted in the computerized tomograms. Asymmetrical herniation of a cerebellar tonsil was noted in the angiograms. The patient's symptoms were relieved by a ventriculo-peritoneal shunt. Although intraventricular pressure was not monitored, the brief duration of the headache and its associated symptoms are best explained by the effect of plateau waves of extreme intracranial hypertension. Asymmetrical tonsillar herniation causing traction of nociceptive vascular structures of the tentorium cerebelli and on cervical nerve roots can account for the focal nature of the headache and associated symptoms. The clinical features and theories of mechanisms of plateau waves are discussed.