To the Editor: I wish to thank Quattrone et al. 1 for their engaging article on chronic daily headache (CDH) and cerebral venous thrombosis (CVT). 1 Their finding that almost 10% of the population with CDH have evidence of CVT is remarkable. However, I do have concerns over the exclusive reliance on MR venography (MRV). In my experience, the area of transverse sinuses (TS) that is indicated on the MR venograms in the article is highly variable, with narrowing, especially when bilateral, not necessarily indicative of venous thrombosis. In other examples presented, the area of abnormality is quite focal, leaving one to wonder why the clot has not extended to involve a larger area of the vessel. It would have been interesting if conventional venography had been included to corroborate the findings. Finally, I will be eagerly anticipating a therapeutic trial of the subset of patients with CDH and CVT.
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A 2002 study studied this question.