Evaluating Cerebral Blood Flow among Patients Experiencing Premenstrual Syndrome with Headache using Duplex Ultrasonography.

INTRODUCTION

This study aimed to demonstrate the relationship between hemodynamic changes in head blood flow and headache during the premenstrual period in patients experiencing premenstrual syndrome.

METHODS

Thirty-two female patients experiencing premenstrual headaches were prospectively examined using carotid and vertebral artery duplex ultrasonography during headache episodes in the premenstrual periods and headache-free periods across two consecutive menstrual cycles. The diameters and areas of both the carotid and vertebral arteries, along with systolic and end-diastolic velocities, pulsatility and resistivity indices, and volumetric flow rates, were measured using grayscale imaging. Total head blood flow was determined as the sum of bilateral common carotid artery and vertebral artery flow volumes. Measurements were compared between participants' premenstrual and menstrual periods.

RESULTS

A statistically significant difference in the diameter of the left external carotid artery was observed between periods with and without headache during the two consecutive menstrual cycles assessed (p = 0.030). Left external carotid artery (p = 0.019), total external carotid artery (p = 0.028), and total head blood volumes (p = 0.030) were significantly higher when headache was present during the premenstrual period than when headache was absent.

DISCUSSION: Towards the end of the luteal phase, the total head blood flow and external carotid artery flow were high due to a decrease in peripheral resistance caused by the decline in progesterone and hormonal fluctuations during this period.

CONCLUSION

Increased flow volume in the external carotid arteries and total head blood flow may be a contributing factor to premenstrual headaches.