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Headache Attributed to Autonomic Dysreflexia: Clinical Presentation, Pathophysiology, and Treatment

  • Uncommon and/or Unusual Headaches and Syndromes (J Ailani, Section Editor)
  • Published:
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Abstract

A patient presenting with marked elevation in blood pressure and concurrent headache often presents a diagnostic challenge for even the most seasoned clinician. When marked hypertension and headache occur in a patient with a history of upper spinal cord injury, the patient should be presumed to have autonomic dysreflexia until proven otherwise. Autonomic dysreflexia can at times trigger headaches, hypertension, and variations in pulse, as well other autonomic signs and symptoms. Autonomic dysreflexia is a medical emergency for which appropriate treatment may be life-saving. In this review, we address the historical origins, risk factors, pathophysiology, diagnostic criteria, clinical presentation, differential diagnosis, and treatment of headache attributed to autonomic dysreflexia. Included are two case presentations from the authors’ clinic, which illustrate the diagnosis and treatment of headache attributed to autonomic dysreflexia.

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Acknowledgments

The authors thank Margaret A. McKinney for her work and artistic contribution for the illustration.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic College of Medicine, 200 First St. SW, Floor 8, Rochester, MN, 55905, USA

    Jaclyn R. Duvall & Carrie E. Robertson

  2. Harvard Medical School, Boston, MA, USA

    Paul G. Mathew

  3. Department of Neurology, Brigham & Women’s Hospital, Boston, MA, USA

    Paul G. Mathew

  4. Department of Neurology, Harvard Vanguard Medical Associates, Braintree, MA, USA

    Paul G. Mathew

Authors
  1. Jaclyn R. Duvall
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Correspondence to Carrie E. Robertson.

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Conflict of Interest

Jaclyn R. Duvall declares no conflict of interest. Paul Mathew is on the Advisory Board for Allergan, Amgen, Biohaven, Cowen, Eli-Lilly, Promius, Revance, Satsuma, Stealth BioTherapeutics, Supernus, and Takeda. Carrie E. Robertson receives honoraria from UpToDate as author and she is also on the Advisory Board for Alder and Eli-Lilly.

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Duvall, J.R., Mathew, P.G. & Robertson, C.E. Headache Attributed to Autonomic Dysreflexia: Clinical Presentation, Pathophysiology, and Treatment. Curr Pain Headache Rep 23, 80 (2019). https://doi.org/10.1007/s11916-019-0818-5

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  • DOI: https://doi.org/10.1007/s11916-019-0818-5

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