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Toma A, De La Garza Ramos R, Altschul DJ. Risk Factors for Headache Disorder in Patients With Unruptured Intracranial Aneurysms. Cureus 2023; 15:e38385. [PMID: 37265887 PMCID: PMC10231404 DOI: 10.7759/cureus.38385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Headache disorders are a prevalent yet frequently underestimated issue in patients with unruptured intracranial aneurysms (UIAs). The primary aim of this study is to systematically examine the incidence, specific characteristics, and associated risk factors of headache disorders in the context of individuals diagnosed with UIAs. Through this investigation, we hope to contribute valuable insights to the current understanding of this complex relationship and potentially inform future diagnostic and treatment approaches. METHODS Data from 146 consecutive patients harboring UIAs were evaluated. The location and morphological characteristics of the aneurysm were analyzed. Factors associated with headache incidence and methods of treatment were investigated. The headache pattern in 48 patients was assessed using self-reported questionnaires. RESULTS A total of 146 patients were identified. Out of 146 patients, 95 (65%) were in the Headache Group (HG) and 51 (35%) were asymptomatic and in the No Headache Group (NHG). Factors associated with a higher likelihood of headache were past or current tobacco, alcohol, and illicit drug use (p=0.029). On average, patients had 1.49 (SD=1) aneurysms in the HG and 1.43 (SD=.92) in the NHG group, respectively. In our series, the size of aneurysms, the status of the aneurysm (treated vs untreated), and the method of treatment did not significantly differ between the groups. There was a high incidence of headaches in patients with aneurysms of the ophthalmic segment (C6) of the internal carotid artery (ICA) and sphenoidal segment (M1) of the middle cerebral artery (MCA). Of 48 patients that completed headache questionnaires, 25 had headaches on more than 15 days a month. The majority of participants (85.4%) reported the severity of their pain as being greater than 5 on a scale of 10, while one-third (33.3%) experienced the maximum pain level of 10 out of 10. CONCLUSION Headache more often occurs in patients with aneurysms of the ophthalmic segment (C6) of the ICA and sphenoidal segment (M1) of the MCA. Its distinctive features are deep pain for more than 15 days a month. Although the treatment of aneurysms reduces the risk of aneurysmal rupture, its efficacy in relieving the headache is still uncertain.
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Affiliation(s)
- Aureliana Toma
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
| | | | - David J Altschul
- Neurological Surgery, Albert Einstein College of Medicine, Bronx, USA
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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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3
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Headache in the development of neurosciences. Neurol Sci 2020; 41:349-350. [DOI: 10.1007/s10072-020-04809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Paolucci M, Longoni M, Agostoni EC. Headache following endovascular procedures. Neurol Sci 2020; 41:407-408. [PMID: 32970239 DOI: 10.1007/s10072-020-04738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Matteo Paolucci
- Department of Neurology and Stroke Unit Cesena-Forlì, Bufalini Hospital, AUSL Romagna, viale Ghirotti 286, 47521, Cesena, Italy
| | - Marco Longoni
- Department of Neurology and Stroke Unit Cesena-Forlì, Bufalini Hospital, AUSL Romagna, viale Ghirotti 286, 47521, Cesena, Italy.
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Su H, Li B, Wang J, Tian C, Cao X, Du Z, Liu X, Liu R, Yu S. Headache attributed to cranial venous sinus stenting: A case series and literature review. Cephalalgia 2019; 39:1277-1283. [PMID: 31067080 DOI: 10.1177/0333102419847752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The diagnostic criteria for headache attributable to cranial venous sinus stenting were first formalized in the recently published third edition of the International Classification of Headache Disorders (ICHD-3). However, the diagnostic criteria for headache caused by cranial venous sinus stenting are based on very few data and the condition is poorly characterized. Objectives To validate the diagnostic criteria for cranial venous sinus stenting headache by retrospectively studying the characteristics of headache in patients with isolated pulsatile tinnitus who underwent curative cranial venous sinus stenting and who had not previously complained of headache. Patients and methods We retrospectively studied clinical, radiological, and manometric data from patients with isolated venous pulsatile tinnitus who had not previously reported headache. All patients underwent lateral sinus stenting in our institution between October 2010 and February 2018. Results Forty eight patients, 47 females and one male, were enrolled. The mean age at symptom onset was 36.2 ± 8.7 years and the mean body mass index was 24.0 ± 3.2 kg/m2. Lateral sinus stenosis was evident in 47 patients and a sigmoid diverticulum in one. Fourteen patients experienced headaches after recovering from general anesthesia. All were female, with a mean age of 35.5 ± 9.6 years. Headache persisted for less than 3 days in six patients (42.8%); for 3 days to 3 months in four (28.6%); and for longer than 3 months in four (28.6%). The headaches were located on the same sides as the cranial venous sinus stents in 13 patients (92.9%) and were principally occipital, being oppressive in nine patients (64.3%) and of moderate intensity in seven (50%). Age at onset of pulsatile tinnitus and body mass index were significantly associated with headache ( p < 0.05; t-test). Conclusion To the best of our knowledge, this is the first study to describe cranial venous sinus stenting headache in detail. We found that de novo headache developed after cranial venous sinus stenting, and was usually mild to moderate, unilateral, but oppressive; almost one-third of such headaches persisted for more than 3 months. Researchers and clinicians must become familiar with this headache spectrum; further prospective studies are required.
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Affiliation(s)
- Hui Su
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Baomin Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Chenglin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiangyu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhihua Du
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xinfeng Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Treatment of refractory headache secondary to intracranial endovascular procedure by transcutaneous electrical nerve stimulation of the occipital nerve. Neurophysiol Clin 2018; 48:309-312. [DOI: 10.1016/j.neucli.2018.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
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Headache due to endovascular procedures. Neurol Sci 2018; 39:93-94. [PMID: 29904871 DOI: 10.1007/s10072-018-3369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
The International Classification of Headache Disorders (ICHD-3 beta) includes headache attributed to intracranial endovascular procedures (EVPs). The aim of this review is to describe the clinical and pathophysiological aspects of headache related to vascular lesions and EVPs. Current studies regarding this issue are contradictory, although generally favouring headache improvement after EVPs. Further large studies are needed to adequately assess the effect of EVPs on headache.
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Abstract
Headache is a very common symptom in the neurointensive care unit (neuroICU). While headache in the neuroICU can be caused by worsening of a pre-existing primary headache disorder, most are secondary to another condition. Additionally, headache can be the presenting symptom of a number of conditions requiring prompt recognition and treatment including subarachnoid hemorrhage, ischemic and hemorrhagic stroke, central nervous system infection, pituitary apoplexy, and cerebral vasoconstriction. The neuroICU also has a unique postoperative population in which postcraniectomy and postcraniotomy headache, postintravascular intervention headache, hyperperfusion syndrome, ventriculitis, medication overuse or withdrawal headache, and hypercapnia may be encountered. Management varies dramatically depending on the etiology of the headache. Overreliance on opiate analgesics may produce significant adverse effects and lengthen ICU stays. However, nonnarcotic medications are increasingly being recognized as helpful in reducing the pain among various postsurgical and headache patients. Taken together, a multimodal approach targeting the underlying pathology and choosing appropriate systemic and local analgesic medications may be the best way to manage headache in critically ill patients.
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Zhang L, Wang Y, Zhang Q, Ge W, Wu X, Di H, Wang J, Cao X, Li B, Liu R, Yu S. Headache improvement after intracranial endovascular procedures in Chinese patients with unruptured intracranial aneurysm: A prospective observational study. Medicine (Baltimore) 2017; 96:e6084. [PMID: 28178166 PMCID: PMC5313023 DOI: 10.1097/md.0000000000006084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate whether there is a long-term improvement in headache of patients with unruptured intracranial aneurysms (UIAs) treated with intracranial endovascular procedures.Using a prospective design, consecutive patients with UIAs with neuroendovascular treatment from January 2014 to December 2014 were asked to participate. Headache outcomes were established before aneurysm treatment and for 6 months following treatment. Factors associated with different headache outcomes were investigated.Ultimately, 58 patients completed the 6-month follow-up. In total, 29 patients had preoperative headache. Six months after the intracranial endovascular procedure, 13 patients (44.8%) stated that their headaches were relieved after endovascular treatment; headache in 1 patient improved slightly, and 12 reported disappearance of headache and marked improvement. Overall, the mean headache scores of 29 patients improved on the self-reported Numeric Rating Scale (NRS) after endovascular treatment (6.00 vs. 2.30; P < 0.001). Patients with pretreatment tension-type headache, more severe headaches, stent-assisted coiling, and stent implantation of the aneurysm were the important disadvantage for patients in improvement of post-procedure headache.Treatment of UIAs resulted in relief of headaches in about half of patients who had headaches pre-operatively.
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Affiliation(s)
- Linjing Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Yunxia Wang
- Department of Neurology, the First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, PR China
| | - Qingkui Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Wei Ge
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Xiancong Wu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Hai Di
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Xiangyu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Baomin Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
- Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, PR China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
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Zhang L, Wu X, Di H, Feng T, Wang Y, Wang J, Cao X, Li B, Liu R, Yu S. Characteristics of Headache After an Intracranial Endovascular Procedure: A Prospective Observational Study. Headache 2016; 57:391-399. [PMID: 27991669 DOI: 10.1111/head.13006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Two editions of the International Classification of Headache Disorders (ICHD) diagnostic criteria for "Headache attributed to an intracranial endovascular procedure" have been published, in 2004 and 2013.1,2 Despite studies that have suggested that the former is not very practical, the ICHD-3 beta did not contain major changes. Moreover, so far no consensus exists regarding characteristics of headache after intracranial endovascular procedure. Thus, there is a need for sound suggestions to improve the ICHD-3 beta diagnostic criteria. METHODS Using a prospective design, we identified consecutive patients with unruptured intracranial aneurysms (UIAs) with neuroendovascular treatment from January 2014 to December 2014. RESULTS In total, 73 patients were enrolled, and 58 patients ultimately completed the 6-month follow-up. After the procedure, five of the 29 patients (17.2%) with pre-existing headache experienced marked worsening after the procedure, while seven of the 29 patients without prior headache developed new-onset headache post-procedurally. The headaches started within 24 hours, with a mean duration of 24-72 hours. The headaches were moderate to severe. The eligibility of these events to be considered headaches caused by neuroendovascular procedures according to the ICHD-3 beta diagnostic criteria for designation was far from ideal. CONCLUSIONS Most cases of markedly worsening headaches and new-onset headaches started within 24 hours and persisted longer than that specified in the ICHD-3 beta diagnostic criteria. Moreover, considering that some items are not very practical, the ICHD-3 beta diagnostic criteria should be revised in the light of recent literature reports.
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Affiliation(s)
- Linjing Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Xiancong Wu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Hai Di
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Tao Feng
- Department of Neurology, Heilongjiang Provincial Hospital, Harbin, PR China
| | - Yunxia Wang
- Department of Neurology, The First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, PR China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Xiangyu Cao
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Baomin Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China.,Department of Neurology, Hainan Branch of Chinese PLA General Hospital, Sanya, PR China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, PR China
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Khan S, Amin FM, Hauerberg J, Holtmannspötter M, Petersen JF, Fakhril-Din Z, Gaist D, Ashina M. Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy. J Headache Pain 2016; 17:73. [PMID: 27550214 PMCID: PMC4993738 DOI: 10.1186/s10194-016-0666-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/13/2016] [Indexed: 01/03/2023] Open
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.
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Affiliation(s)
- Sabrina Khan
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600 Denmark
| | - Faisal Mohammad Amin
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600 Denmark
| | - John Hauerberg
- Department of Neurosurgery, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Markus Holtmannspötter
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Falkenberg Petersen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600 Denmark
| | - Zainab Fakhril-Din
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600 Denmark
| | - David Gaist
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600 Denmark
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Headache in subarachnoid hemorrhage and headache attributed to intracranial endovascular procedures. Neurol Sci 2016; 36 Suppl 1:67-70. [PMID: 26017515 DOI: 10.1007/s10072-015-2193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Headache is a critical problem in the emergency setting. In this paper we briefly review the epidemiological data regarding headache in Subarachnoid Hemorrhage (SAH), considering the role of headache as a warning symptom and the other clinical manifestation of SAH. We have also introduced a recent clinical entity, represented by headache associated to intracranial endovascular procedures (IEPs).
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Baron EP, Hui FK, Kriegler JS. Case Report of Debilitating Headaches and a Coexisting Ophthalmic Artery Aneurysm: An Indication for Treatment? Headache 2015; 56:567-72. [PMID: 26234769 DOI: 10.1111/head.12632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We present a case of a patient who had severe unilateral headaches related to a small, unruptured ophthalmic artery aneurysm, who experienced complete headache cessation following endovascular coiling. BACKGROUND Small unruptured intracranial aneurysms are generally managed and followed conservatively due to minimal risk of rupture. Headaches are frequently reported in patients with intracranial aneurysms, but these aneurysms are typically considered incidental and unrelated, given the undefined association between headaches and most aneurysms. CONCLUSION There may be some unruptured intracranial aneurysms that can cause intractable headaches and warrant interventional treatment. Future prospective studies are needed that compare pre- and post-procedure headache character and diagnosis, aneurysm characteristics such as size, location, orientation, and shape, type of aneurysm repair with materials used, and other potential risk factors for worsening post-procedure headache in order to better predict headache association to aneurysms, as well as outcomes following endovascular aneurysm treatment.
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Affiliation(s)
- Eric P Baron
- Department of Neurology, Center for Headache and Pain, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Ferdinand K Hui
- Cerebrovascular Center, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
| | - Jennifer S Kriegler
- Department of Neurology, Center for Headache and Pain, Cleveland Clinic, Neurological Institute, Cleveland, OH, USA
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Baron EP. Headache, cerebral aneurysms, and the use of triptans and ergot derivatives. Headache 2015; 55:739-47. [PMID: 25903747 DOI: 10.1111/head.12562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Uncertainty exists regarding the correlation between unruptured cerebral aneurysms and their role in headache etiology. It is also unclear whether surgical endovascular treatment may improve or worsen the headache, and if there are predictable factors for headache outcome such as pre-existing headache features, aneurysm characteristics, or other medical history. There is debate regarding safe treatment of migraine in patients with aneurysms, both before and after endovascular treatments. Particularly, there is hesitancy to use the triptans and ergot derivatives such as dihydroergotamine because of their vasoconstrictive effects and concern for adverse events related to the aneurysm such as aneurysmal instability and rupture. OBJECTIVE To review the literature regarding the anatomy, pathophysiology, and association between headache, untreated vs surgically treated aneurysms, and the use of triptans and ergot derivatives for migraine treatment in this setting. CONCLUSION Associations between some headaches and aneurysms may exist. Some chronic headaches may respond to surgical aneurysm repair while others may worsen. These associations are undefined by current literature because of variable results, study methods, and limited data. Prospective studies are needed which incorporate pre- and post-procedure headache character and diagnosis, aneurysm characteristics, type of aneurysm repair, associated risk factors for worsening post-procedure headache, and ultimately combining all of these data to better predict headache outcome following surgical aneurysm treatment. Lastly, the caution and avoidance of triptan and ergot derivative use for migraine in the setting of aneurysm is not supported by the current evidence, and much of this concern may be excessive and unwarranted, although more evidence confirming safety is needed.
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Affiliation(s)
- Eric P Baron
- Department of Neurology, Cleveland Clinic Neurological Institute, Center for Headache and Pain, Cleveland, OH, USA
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Lebedeva ER, Busygina AV, Kolotvinov VS, Sakovich VP, Olesen J. Remission of migraine after clipping of saccular intracranial aneurysms. Acta Neurol Scand 2015; 131:120-6. [PMID: 25288229 DOI: 10.1111/ane.12292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Unruptured saccular intracranial aneurysm (SIA) is associated with an increased prevalence of migraine, but it is unclear whether this is altered by clipping of the aneurysm. The aim of our study was to determine whether remission rate of migraine and other recurrent headaches was greater in patients with SIA after clipping than in controls. METHODS We prospectively studied 87 SIA patients with migraine or other recurrent headaches. They were interviewed about headaches in the preceding year before and 1 year after clipping using a validated semi-structured neurologist conducted interview. The remission rates of migraine and tension-type headache (TTH) in these patients were compared to 92 patients from a headache center. Diagnoses were made according to the ICHD-2. RESULTS During 1 year preceding rupture 51 patients with SIA had migraine. During the year after clipping, this was reduced by 74.5% (P < 0.0001). At first encounter, 47 control patients had migraine during the preceding year, and during 1 year of treatment, it was 41, a reduction 12.8% (P > 0.5). The decrease of migraine in SIA patients was significantly higher than in controls: 74.5% vs 12.8% (P < 0.001). A history of TTH was given by 33 patients with SIA during the year preceding rupture and by 44 during 1 year after clipping (P > 0.75). Forty-one control patients had TTH, 27 after 1 year of treatment, a reduction 34.1% (P < 0.05). No factors except clipping of the aneurysm could explain the remission of migraine. CONCLUSIONS Migraine prevalence in patients with SIA decreases significantly after clipping. Further comparative studies of migraine after coiling vs clipping in SIA patients are needed.
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Affiliation(s)
- E. R. Lebedeva
- Department of Neurology and Neurosurgery; the Urals State Medical University; Yekaterinburg Russia
- International Headache Center “Europe-Asia”; Yekaterinburg Russia
| | - A. V. Busygina
- International Headache Center “Europe-Asia”; Yekaterinburg Russia
| | - V. S. Kolotvinov
- Department of Neurosurgery; Regional Neurosurgical Center; City Hospital No. 40; Yekaterinburg Russia
| | - V. P. Sakovich
- Department of Neurology and Neurosurgery; the Urals State Medical University; Yekaterinburg Russia
| | - J. Olesen
- Danish Headache Center; Department of Neurology; Glostrup Hospital; University of Copenhagen; Copenhagen Denmark
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Abstract
Cranial or cervical vascular disease is commonly associated with headaches. The descriptions may range from a thunderclap onset of a subarachnoid hemorrhage to a phenotype similar to tension type headache. Occasionally, this may be the sole manifestation of a potentially serious underlying disorder like vasculitis. A high index of clinical suspicion is necessary to diagnose the disorder. Prompt recognition and treatment is usually needed for many conditions to avoid permanent sequelae that result in disability. Treatments for many conditions remain challenging and are frequently controversial due to paucity of well controlled studies. This is a review of the recent advances that have been made in the diagnosis or management of these secondary headaches.
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Olesen J, Lebedeva E. Comment on headache following intracranial neuroendovascular procedures. Headache 2013; 53:383-4. [PMID: 23432445 DOI: 10.1111/j.1526-4610.2013.02272.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lebedeva ER, Gurary NM, Sakovich VP, Olesen J. Migraine before rupture of intracranial aneurysms. J Headache Pain 2013; 14:15. [PMID: 23574797 PMCID: PMC3620434 DOI: 10.1186/1129-2377-14-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/07/2013] [Indexed: 12/04/2022] Open
Abstract
Background Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA. Methods In a prospective case–control study 199 consecutive patients with SIA (103 females and 96 males, mean age: 43.2 years) received a semistructured face to face interview focusing on past headaches. All were admitted to hospital mostly because of rupture (177) or for unruptured aneurysm (22). In parallel we interviewed 194 blood donors (86 females, 108 males, mean age: 38.4 years). Diagnoses were made according to the International Headache Society criteria. Aneurysms were diagnosed by conventional cerebral angiography. Results During the year before rupture, 124 (62.3%) had one or more types of headache. These headaches included: migraine without aura (MO): 78 (39.2%), migraine with aura (MA): 2 (1%), probable migraine (PM): 4 (2%), tension-type headache (TTH): 39 (19.6%), cluster headache (CH): 2 (1%), posttraumatic headaches (PH): 2 (1%). 1-year prevalence of headaches in controls was 32.5% (63 patients out of 194), they included: TTH: 45 (23.1%), MO: 17(8.8%), PH: 1(0.5%). Only the prevalence of MO was significantly higher in patients with SIA (OR 6.7, 95% CI 3.8-11.9, p < 0.0001). Conclusions Unruptured SIA cause a marked increase in the prevalence of migraine without aura but not in the prevalence of other types of headache.
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Affiliation(s)
- Elena R Lebedeva
- Department of Neurology and Neurosurgery, The Urals State Medical Academy, 124 Chkalova str,, ap,94, Yekaterinburg, Russia.
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