6.7.2 Angiography headache

Description:
Headache caused directly by cerebral angiography, either diffuse, burning and severe or, in people with migraine, with the clinical features of a migraine attack.

Diagnostic criteria:
A. Any new headache fulfilling criterion C
B. Intra-arterial carotid or vertebral angiography has been performed
C. Evidence of causation demonstrated by at least two of the following:

    1. headache has developed during the angiography
    2. headache has resolved within 72 hr after the end of the angiography
    3. headache is either of the following:

      a) diffuse, burning and severe
      b) in a patient with migraine, having the features of 1.1 Migraine without aura or 1.2 Migraine with aura

D. Not better accounted for by another ICHD-3 diagnosis.

Comments:
Intracarotid or intravertebral injection of contrast induces a diffuse severe headache with a burning sensation, which resolves spontaneously. It can also trigger a migraine attack in a person who has 1. Migraine. In the latter case, the patient should have both diagnoses: the appropriate subtype of 1. Migraine and 6.7.2 Angiography headache.

Contrast angiography is contraindicated in patients affected by any subform of 1.2.3 Hemiplegic migraine because it may trigger a life-threatening attack, with prolonged hemiplegia and coma.