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

Authors

  • Jan Hannerz MD, PhD,

    1. Departments of Neurology (Dr. Hannerz), Hospital Physics, Section of Nuclear Medicine (Mr. Schnell and Dr. Larsson), and Diagnostic Radiology (Dr. Jacobsson), Karolinska Hospital, Stockholm, Sweden.
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  • P.-O. Schnell MSc,

    1. Departments of Neurology (Dr. Hannerz), Hospital Physics, Section of Nuclear Medicine (Mr. Schnell and Dr. Larsson), and Diagnostic Radiology (Dr. Jacobsson), Karolinska Hospital, Stockholm, Sweden.
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  • Stig Larsson PhD,

    1. Departments of Neurology (Dr. Hannerz), Hospital Physics, Section of Nuclear Medicine (Mr. Schnell and Dr. Larsson), and Diagnostic Radiology (Dr. Jacobsson), Karolinska Hospital, Stockholm, Sweden.
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  • Hans Jacobsson MD, PhD

    1. Departments of Neurology (Dr. Hannerz), Hospital Physics, Section of Nuclear Medicine (Mr. Schnell and Dr. Larsson), and Diagnostic Radiology (Dr. Jacobsson), Karolinska Hospital, Stockholm, Sweden.
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Address all correspondence to Dr. Jan Hannerz, Department of Neurology, Karolinska Hospital, SE-171 76 Stockholm, Sweden.

Abstract

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.

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