The Value of Air Encephalography and Cererral Arteriography in the Diagnosis of Headache

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ALTHOUGH pain in the head is a common and stubborn complaint, the underlying cause usually is benign, and its source more often outside the cranium than within.

The most common pain producing mechanism is an excessive relaxation and dilatation of the extracranial arteries; these vessels are for the most part branches of the external carotid artery. Thus, extracranial vascular headache is the most prevalent type. As a consequence of difference in location and clinical pattern, various names have been given to this form of head pain: migraine, atypical migraine, histamine cephalgia, atypical facial neuralgia, tension vascular and hypertensive headache. The underlying mechanism appears to be similar in all of these, and basically they are all related. A strong familial tendency has also been noted, and emotional and nervous tension factors usually play an important role. It frequently occurs in a setting of tension, fatigue, or frustration, or in the period of relaxation afterwards.

The second most common pain producing mechanism is related to sustained contractions of the muscles of the head and neck which give rise to a muscle tension headache. This may be primary or secondary to any other pain in the head. As is true of the extracranial vascular type, the primary muscle tension headache is usually due to various emotional and nervous factors.

In the past the role of the eyes, nose and sinuses in the production of head pain has been stressed. Notwithstanding the voluminous literature on the subject, it appears that these structures do not . . .



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