The role of the cerebral and cervical arteries ultrasound examination in migraine diagnosis

Abstract

Migraine as a primary disease is a very common problem. However, headache attacks that mimic migraine attacks can often be secondary, due to various type of pathology of cervical and cerebral vessels. The common or internal carotid arteries, vertebral arteries, and the anterior, middle, and posterior cerebral arteries, the anterior and posterior communicating arteries, or the basilar artery may be affected. Identification of such diseases is the primary task of differential diagnosis in migraine, especially migraine with aura, and secondary cephalgic syndromes, since in some cases we are talking about life-threatening conditions that require immediate intervention: rupture of brain artery aneurysm or arteriovenous malformation, dissection of one or more cervical arteries. Various types of ultrasound are successfully used to diagnose vascular diseases, ranging from “blind” dopplerography to three-dimensional reconstruction of blood vessels and contrast ultrasound. The defect of the oval window can be complicated by paradoxical microembolism, that can lead to impaired cerebral circulation. This anatomical feature is also available for diagnosis using ultrasound; and once the diagnosis is established, surgical closure of the foramen ovale defect reduces not only the prevalence of migraine with aura attacks, but also the risk of the stroke. This review article discusses the clinical and diagnostic aspects of cerebral aneurysms and arteriovenous malformations, dissection of brachiocephalic arteries’ wall. It also discusses the diagnosis of cerebral arteries’ microembolism, caused by the paradoxical movement of material emboli through non-closure of the foramen ovale, as the cause of one of the most formidable complications of migraine - stroke.