Chronic Headache Attributed to Vertebrobasilar Insufficiency

Abstract

Vertebrobasilar insufficiency, a condition characterized by poor blood flow to the posterior portion of the brain, can cause headaches. However, the exact underlying mechanism is not yet fully understood. The patient enrolled in our study reported experiencing intermittent headaches radiating from the left shoulder, similar to chronic tension-type headaches. His aggravated headache and severe left vertebral artery stenosis were detected by brain computed tomography angiography. Stent insertion successfully expanded the patient's narrowed left vertebral artery orifice. Subsequently, the patient's headaches improved without recurrence during the one-year follow-up period. In summary, chronic headaches attributed to vertebrobasilar insufficiency in this study, improved after stent insertion to reverse severe left vertebral artery stenosis.

Keywords: aneurysm; headache; stent; vertebral artery; vertebrobasilar insufficiency.

Figure 1

(a) Stenosis from the left VA ostium confirmed on subclavian artery angiography. (b) The location of the balloon-mounted stent (Biotronik, Pro-kinteic Energy 5.0 × 13 mm) confirmed under fluoroscopic guidance. (c,d) Due to the atheroma of the VA ostium, the balloon-mounted stent (arrow) distally migrated during inflation. It can be observed that the atheroma moved down from the VA origin as a result (red block). (e) Additional balloon angioplasty using Submarine 6–20 was conducted in the ostium. (f) The stent is well-maintained (arrow) and VA flow improved.