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. 2016 Dec;17(1):73.
doi: 10.1186/s10194-016-0666-1. Epub 2016 Aug 22.

Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy

Sabrina Khan  1 , Faisal Mohammad Amin  2 , John Hauerberg  3 , Markus Holtmannspötter  4 , Julie Falkenberg Petersen  2 , Zainab Fakhril-Din  2 , David Gaist  5   6 , Messoud Ashina  2
Affiliations

Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy

Sabrina Khan et al. J Headache Pain. 2016 Dec.

Abstract

Background: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral arteriovenous malformations (AVMs) and aneurysms.

Methods: A total of 324 patients underwent EVT treatment for aneurysms and AVMs at the Danish National Hospital from January 2012 to December 2014. We applied strict exclusion criteria in order to minimize the effect of other factors on headache occurrence, e.g., craniotomy. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire. Headaches were classified according to ICHD-III beta criteria.

Results: The 59 patients underwent treatment of aneurysms (n = 43), cranial dural fistulas (n = 11), and AVMs (n = 5). There was a significant increase in overall headache (p = 0.017) and tension-type headache (TTH) (p = 0.012) within the first 3 months after EVT compared to 1 month before EVT. However, at interview time (median 2.5 years post-EVT), the increase in overall headache, migraine, and tension-type headache was not statistically significant. A minority of patients experienced headaches for the first time within 3 months of their EVT (migraine 4, TTH 10). At interview time, 50 % of these new headaches still persisted.

Conclusion: Our results suggest a temporary increase in headache in the first 3 months after EVT, which normalizes over time. Clinicians may use this knowledge to better inform their patients of functional outcomes after their EVT procedure.

Keywords: Aneurysm; Arteriovenous malformation; Endovascular therapy; Headache; Post procedure; Risk.

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Figures

Fig. 1
Fig. 1
Study enrolment
Fig. 2
Fig. 2
Localization of treated aneurysms, arteriovenous malformations, and dural arteriovenous fistulas. VA = vertebral artery, BA = basilar artery, ICA = internal carotid artery, MCA = middle cerebral artery, ACOM = anterior communicating artery, PCOM = posterior communicating artery, PCA = posterior cerebral artery. Another 16 localizations were distributed as follows: Left MCA + ICA = 1; bilateral ICA = 1; ophthalmic artery = 1; cavernous sinus = 1; left sigmoid sinus = 1, and unspecified locations (n = 11)
Fig. 3
Fig. 3
Headache status before and after endovascular treatment. Numbers represent patients. Overall headache includes migraine with aura, migraine without aura, tension-type headache, probable migraine, probable tension-type headache, cluster headache, and unclassified headache. Red dotted line represents the endovascular procedure
Fig. 4
Fig. 4
Distribution of de novo headaches and known headache after endovascular treatment. Numbers represent patients. TTH = tension-type headache
See this image and copyright information in PMC

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