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By Richard Peatfield MA, MD, MRCP (auth.)
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Arteriovenous Malformations Knotted masses of distended blood vessels forming a high flow fistulous communi- 20 Organic Causes of Headache cation between arteries and veins may occur in all parts of the brain. They are considered benign, but the high pressure of blood may cause inexorable expansion. The majority of these malformations come to medical attention after rupturing, into either the brain substance or the subarachnoid space, but they can also cause epilepsy, which can be either focal or generalised.
However, in a recent major review Bruyn (1984) suggests on statistical grounds that there is an association between migraine-like symptoms and arteriovenous malformations, but he stresses that attacks are usually atypical, being of late onset and brief duration and often associated with coma, epilepsy or permanent physical signs. The patients are predominantly male and a family history of migraine is rare. Arteriovenous malformations can be managed by surgical excision, embolisation or stereotactic radiation (Stein and Wolpert 1980).
1982), anticonvulsants (for example carbamazepine or valproate) or combinations of these (Raftery 1979) have also been shown to be of benefit. Blood Pressure It is now clear that headache is only a symptom of severe or malignant (accelerated) hypertension-most patients with mild or moderate hypertension are free from symptoms (British Medical Journal 1973), though the control of the blood pressure in these patients will reduce the prevalence of headache (Bulpitt et al. 1976). In malignant hypertension the headaches are characteristically severe, of recent onset and localised, though this is not always in the occiput.
Headache by Richard Peatfield MA, MD, MRCP (auth.)