Dear Editor,
I have read with great enthusiasm the genuinely inspired article by Smith et al.
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recently. Briefly they have retrospectively assessed the non-pelvic symptoms of 45 patients with venous-origin chronic pelvic pain (VO-CPP) namely pelvic congestion syndrome. They have reported unignorable rates of common symptoms of migraines, brain fog, anxiety attacks, sweating, hip pain, abdominal bloating, diarrhea and constipation.
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Moreover, they have observed significant improvement in above mentioned non pelvic symptoms after catheter-based treatment of pelvic venous congestion. Among those non-pelvic symptoms, I would like to focus on the prevalence of migraine in regard to its’ possible pathophysiologic implications with pelvic congestion syndrome. Emerging evidences indicate that peripheral varicose vein, varicocele, hemorrhoids, and pelvic congestion syndrome are localized manifestation of diffuse systemic vascular disease rather than individual findings of not localized diseases of related organs or system.2–4 Therefore, these pathologies have been classified under the term of dilating venous disease (DVeD). It has recently been demonstrated that venous leg symptoms measured by VEINNES-Sym questionnaire are significantly associated with migraine.
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This association implies that functional or structural abnormality of venous wall or venous congestion is likely to be a contributing factor in the neurovascular pathogenesis of migraine. Likewise, cerebral venous congestion and venous hypertension have also been thought to be involved in the pathogenesis of migraine and the congestion in cerebral veins has been shown to aggravate the migraine headache.5,6 Within this context presence of migraine symptoms in patients with pelvic venous congestion can be regarded as a distinct manifestation of systemic vascular wall abnormality. Further studies are warranted to assess pathophysiologic and symptomatic aspects of pelvic congestion syndrome or DVeD.
