Headache

In brief: Headache is a clinical symptom of pain in the head. It may occur as a primary headache disorder or in a secondary context related to another condition or event.

Use in moyamoya disease

Headache is common in people with moyamoya but is not specific enough to diagnose blood-flow change, stroke, or hemorrhage by itself. Pain may resemble migraine, tension headache, pressure, or postoperative discomfort. Proposed mechanisms include altered cerebral blood flow, collateral vessel signaling, dural or scalp factors, and primary headache disorders that happen independently of moyamoya. [1]

A useful evaluation considers onset, pattern, neurologic symptoms, medicines, hydration, sleep, menstrual or hormonal factors, blood pressure, and relation to surgery. Treatment should account for the person’s cerebrovascular status; common headache medicines are not automatically appropriate for every patient.

Use in multiple sclerosis

Headache can occur in a person with MS, but it is not by itself evidence of an MS relapse or a new lesion. Migraine, tension-type headache, medicine effects, sleep disturbance, infection, and other primary or secondary causes still require ordinary clinical assessment. [2]

A headache accompanied by abrupt major weakness, marked confusion, seizure, fever with severe illness, or sudden severe visual change should not be assumed to be part of MS.

Clinical detail

In moyamoya, headache frequency may improve, persist, or occasionally worsen after revascularization, and headache outcome alone is not a reliable measure of bypass success. In MS, headache pattern should be evaluated independently of disease activity unless other evidence links the episode to a neurologic event.