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Meyer T, Riabikin A, Werner CJ. Development of a cluster-like headache after a stent-assisted implantation of an endovascular WEB device. BMJ Case Rep 2022; 15:e251431. [PMID: 36379623 PMCID: PMC9668022 DOI: 10.1136/bcr-2022-251431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
After interdisciplinary consent, a male patient in his 50s received endovascular treatment of an innocent supraophthalmic aneurysm of the internal carotid artery with a WEB (woven endo bridge) device and stenting. In the medical history, a migraine with aura was reported. A week after intervention, the patient developed an ipsilateral cluster-like headache responsive to classical interventions. Inflammation of the carotid wall near the stent was demonstrated to be associated with the headaches and was responsive to steroid treatment.The presented case demonstrates that postinterventional headache comprises more headache entities than the often reported migraine and tension-type headache with a considerable impact on the patients' quality of life. The case supports the vascular hypothesis of cluster headache pathophysiology, potentially contradicting current models and assumptions.
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Affiliation(s)
- Tareq Meyer
- Department of Neurology, RWTH Aachen University Medical Faculty, Aachen, Nordrhein-Westfalen, Germany
| | - Alexander Riabikin
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Medical Faculty, Aachen, Nordrhein-Westfalen, Germany
| | - Cornelius Johannes Werner
- Department of Neurology, RWTH Aachen University Medical Faculty, Aachen, Nordrhein-Westfalen, Germany
- Department of Neurology and Geriatrics, Johanniter-Krankenhaus Genthin-Stendal GmbH, Stendal, Saxony-Anhalt, Germany
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Maciel CB, Barlow B, Lucke-Wold B, Gobinathan A, Abu-Mowis Z, Peethala MM, Merck LH, Aspide R, Dickinson K, Miao G, Shan G, Bilotta F, Morris NA, Citerio G, Busl KM. Acute Headache Management for Patients with Subarachnoid Hemorrhage: An International Survey of Health Care Providers. Neurocrit Care 2022; 38:395-406. [PMID: 35915347 DOI: 10.1007/s12028-022-01571-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe headaches are common after subarachnoid hemorrhage. Guidelines recommend treatment with acetaminophen and opioids, but patient data show that headaches often persist despite multimodal treatment approaches. Considering an overall slim body of data for a common complaint affecting patients with SAH during their intensive care stay, we set out to assess practice patterns in headache management among clinicians who treat patients with SAH. METHODS We conducted an international cross-sectional study through a 37-question Web-based survey distributed to members of five professional societies relevant to intensive and neurocritical care from November 2021 to January 2022. Responses were characterized through descriptive analyses. Fisher's exact test was used to test associations. RESULTS Of 516 respondents, 329 of 497 (66%) were from North America and 121 of 497 (24%) from Europe. Of 435 respondents, 379 (87%) reported headache as a major management concern for patients with SAH. Intensive care teams were primarily responsible for analgesia during hospitalization (249 of 435, 57%), whereas responsibility shifted to neurosurgery at discharge (233 of 501, 47%). Most used medications were acetaminophen (90%), opioids (66%), corticosteroids (28%), and antiseizure medications (28%). Opioids or medication combinations including opioids were most frequently perceived as most effective by 169 of 433 respondents (39%, predominantly intensivists), followed by corticosteroids or combinations with corticosteroids (96 of 433, 22%, predominantly neurologists). Of medications prescribed at discharge, acetaminophen was most common (303 of 381, 80%), followed by opioids (175 of 381, 46%) and antiseizure medications (173 of 381, 45%). Opioids during hospitalization were significantly more prescribed by intensivists, by providers managing higher numbers of patients with SAH, and in Europe. At discharge, opioids were more frequently prescribed in North America. Of 435 respondents, 299 (69%) indicated no change in prescription practice of opioids with the opioid crisis. Additional differences in prescription patterns between continents and providers and while inpatient versus at discharge were found. CONCLUSIONS Post-SAH headache in the intensive care setting is a major clinical concern. Analgesia heavily relies on opioids both in use and in perception of efficacy, with no reported change in prescription patterns for opioids for most providers despite the significant drawbacks of opioids. Responsibility for analgesia shifts between hospitalization and discharge. International and provider-related differences are evident. Novel treatment strategies and alignment of prescription between providers are urgently needed.
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Affiliation(s)
- Carolina B Maciel
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA.,Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brooke Barlow
- Department of Pharmacy, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Arravintha Gobinathan
- Departments of Microbiology and Anthropology, University of Florida, Gainesville, FL, USA
| | - Zaid Abu-Mowis
- Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Mounika Mukherjee Peethala
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA
| | - Lisa H Merck
- Department of Emergency Medicine College of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, Istituto delle Scienze Neurologiche di Bologna, Istituto di Ricovero e Cura a Carattere Scientifico, Bologna, Italy
| | - Katie Dickinson
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA
| | - Guanhong Miao
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, FL, USA.,Research Design and Data Coordinating Center, Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Federico Bilotta
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Nicholas A Morris
- Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Katharina M Busl
- Department of Neurology, College of Medicine, University of Florida, McKnight Brain Institute, L3-100, 1149 Newell Drive, Gainesville, FL, 32608, USA. .,Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA.
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Gallo D, Manrique L, Polanco M, González-Mandly A, Torres E, Palacio E, Vázquez JL, Pérez-Pereda S, González-Quintanilla V, Madera J, Pascual J. De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study. J Headache Pain 2022; 23:85. [PMID: 35864440 PMCID: PMC9306161 DOI: 10.1186/s10194-022-01455-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background and aim Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke. Methods Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire. Results One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8–35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours. Conclusions Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01455-3. - About one third of the patients who undergo a thrombectomy for acute stroke
experience headache directly related to the procedure. - Having a previous history of primary headache is associated with the presence
of headache after thrombectomy. - Headache related to thrombectomy usually coincides with the distribution of the affected artery, although it is bilateral in 45% of the cases, mostly oppressive, of an average duration between 1 and 2 days and of a moderate intensity.
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Affiliation(s)
- Daniel Gallo
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Leire Manrique
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Marcos Polanco
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Andrés González-Mandly
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Eduardo Torres
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Enrique Palacio
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - José Luis Vázquez
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Sara Pérez-Pereda
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Vicente González-Quintanilla
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Jorge Madera
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Julio Pascual
- Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain.
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