Extracranial vascular changes and the source of pain in migraine headache.

The extracranial circulation of 66 migrainous patients was assessed during unilateral headache by recording the pulse amplitude of the superficial temporal artery and its main frontal branch, by facial thermography, and by changes in the intensity of headache when temporal or carotid arteries were compressed. Amplitude of pulsation of the superficial temporal artery did not differ between headache and headache-free sides but the amplitude of its frontal branch was increased on the headache side, specifically in a subgroup of patients whose headache was relieved by compressing the superficial temporal artery ("extracranial vascular" group). Facial thermograms demonstrated significant differences in heat loss from the temples and orbits between migrainous patients and controls, frontotemporal changes being more conspicuous in the extracranial vascular group. It was concluded that dilatation of the superficial temporal artery and its branches contributes substantially to migraine headache in only a minority of patients.