From the Guidelines
Chronic cerebral microvascular disease does not typically cause headaches as a primary symptom. While it's possible that the condition could contribute to headaches in some individuals, there isn't strong evidence to support a direct causal relationship, as noted in a 2019 review of cerebral small vessel disease published in Alzheimer's and Dementia 1. Chronic microvascular disease primarily affects small blood vessels in the brain and is more commonly associated with symptoms such as:
- Cognitive decline
- Mood changes
- Difficulties with balance and walking The altered blood flow resulting from this condition could potentially lead to headaches in some cases, but this is not considered a characteristic feature of the disease. Key aspects of cerebral small vessel disease, including its definition and manifestations, are discussed in the 2019 review, which provides a comprehensive overview of the condition 1. If you're experiencing persistent headaches and are concerned about underlying causes, it's essential to consult with a healthcare provider for a proper evaluation, as there are many other potential causes of chronic headaches that should be considered.
From the Research
Chronic Cerebral Microvascular Disease and Headaches
- Chronic cerebral microvascular disease can cause headaches, as headache is a common symptom of chronic cerebrovascular diseases 2.
- Headache may be the predominant symptom in the early stages of chronic cerebrovascular diseases and resolve in the later stages of the disease 2.
- The severity, nature, and course of headache cannot be considered as reliable signs of cerebrovascular disease 2.
Characteristics of Headaches in Cerebrovascular Diseases
- Headache associated with cerebrovascular diseases lacks clear-cut characteristics and may resemble a migraine attack, tension-type headache, or cluster headache 3.
- The characteristics of headache can vary depending on the type of cerebrovascular disease, such as subarachnoid aneurysmal hemorrhage, cerebral vasoconstriction syndrome, and cervicocerebral artery dissection 3.
Cerebral Microvascular Disease and White Matter Hyperintensities
- Cerebral microangiopathy often manifests as white matter hyperintensities (WMH) on T2-weighted MR images and is associated with elevated stroke risk 4.
- WMH volume was asymmetric in most subjects with chronic steno-occlusive disease, with higher volumes ipsilateral to the stenosis 4.
- Cerebrovascular reactivity (CVR) was lower in ipsilateral WMH compared to contralateral normal-appearing white matter and contralateral WMH 4.
Migraine and Cerebral Small Vessel Disease
- Migraine was associated with white matter hyperintensities (WMHs) and Virchow-Robin spaces (VRSs) in a case-control study 5.
- Age, education level, attack duration, and attack frequency were independent risk factors for Scheltens score and volume of WMH in migraineurs 5.
- Migraine aura, attack frequency, and education level were correlated with the number of VRSs 5.