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Zhang H, Han H, Ma L, Li R, Li Z, Li A, Yuan K, Zhu Q, Wang C, Zhang Y, Zhang H, Gao D, Guo G, Kang S, Ye X, Li Y, Sun S, Wang H, Hao Q, Chen Y, Wang R, Chen X, Zhao Y. A comprehensive analysis of patients with cerebral arteriovenous malformation with headache: assessment of risk factors and treatment effectiveness. J Headache Pain 2024; 25:72. [PMID: 38714978 PMCID: PMC11075233 DOI: 10.1186/s10194-024-01774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Due to the high mortality and disability rate of intracranial hemorrhage, headache is not the main focus of research on cerebral arteriovenous malformation (AVM), so research on headaches in AVM is still scarce, and the clinical understanding is shallow. This study aims to delineate the risk factors associated with headaches in AVM and to compare the effectiveness of various intervention treatments versus conservative treatment in alleviating headache symptoms. METHODS This study conducted a retrospective analysis of AVMs who were treated in our institution from August 2011 to December 2021. Multivariable logistic regression analysis was employed to assess the risk factors for headaches in AVMs with unruptured, non-epileptic. Additionally, the effectiveness of different intervention treatments compared to conservative management in alleviating headaches was evaluated through propensity score matching (PSM). RESULTS A total of 946 patients were included in the analysis of risk factors for headaches. Multivariate logistic regression analysis identified that female (OR 1.532, 95% CI 1.173-2.001, p = 0.002), supply artery dilatation (OR 1.423, 95% CI 1.082-1.872, p = 0.012), and occipital lobe (OR 1.785, 95% CI 1.307-2.439, p < 0.001) as independent risk factors for the occurrence of headaches. There were 443 AVMs with headache symptoms. After propensity score matching, the microsurgery group (OR 7.27, 95% CI 2.82-18.7 p < 0.001), stereotactic radiosurgery group(OR 9.46, 95% CI 2.26-39.6, p = 0.002), and multimodality treatment group (OR 8.34 95% CI 2.87-24.3, p < 0.001) demonstrate significant headache relief compared to the conservative group. However, there was no significant difference between the embolization group (OR 2.24 95% CI 0.88-5.69, p = 0.091) and the conservative group. CONCLUSIONS This study identified potential risk factors for headaches in AVMs and found that microsurgery, stereotactic radiosurgery, and multimodal therapy had significant benefits in headache relief compared to conservative treatment. These findings provide important guidance for clinicians when developing treatment options that can help improve overall treatment outcomes and quality of life for patients.
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Affiliation(s)
- Haibin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Heze Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Ma
- Center for Cerebrovascular Research, University of California, San Francisco, CA, USA
| | - Ruinan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhipeng Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anqi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kexin Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qinghui Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chengzhuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yukun Zhang
- Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Hongwei Zhang
- Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Dezhi Gao
- Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Geng Guo
- Department of Emergency, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Shuai Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Shibin Sun
- Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Yuanli Zhao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Mezaal M, Abdulelah MM, Mehanna RA. Dramatic Effect of Botox Injection in Disabling Chronic Migraine Secondary to Inoperable Cerebral Arteriovenous Malformation. Cureus 2024; 16:e53326. [PMID: 38435940 PMCID: PMC10906972 DOI: 10.7759/cureus.53326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Arteriovenous malformation is a developmental anomaly of the vascular system characterized by arteriovenous shunt through a collection of tortuous vessels without intervening capillary bed. Brain arteriovenous malformations (AVMs) may cause hemorrhagic stroke, epilepsy, and chronic headache. Migraine with aura was reported in up to 58% of females with AVM. A 23-year-old female presented with episodes of severe left-side headache for five months, throbbing in character with photophobia, phonophobia, and nausea. Brain MRI showed a large AVM in the left cerebellar hemisphere. She was diagnosed with grade six AVM, which is inoperable, and secondary migraine. Her migraine symptoms didn't respond to oral medications. However, it responded dramatically to Botox injections. Seven days after Botox injection, her headache disappeared, and her well-being improved. Three years post-diagnosis and treatment, she got married, then three months later became pregnant. During pregnancy, she followed up with neurology, obstetrics, and gynecology. She was delivered by cesarean section to minimize the risk of intracranial hemorrhage and delivered without complications. The female patient in this case with migraine secondary to inoperable brain AVM treated with Botox; she got married and delivered by C-section without complications. This case raises the following important lessons: large AVMs can present with migraine only, and Botox has a dramatic effect on the treatment and the ability to have a safe pregnancy and delivery in large AVM cases.
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Pelzer N, de Boer I, van den Maagdenberg AMJM, Terwindt GM. Neurological and psychiatric comorbidities of migraine: Concepts and future perspectives. Cephalalgia 2023; 43:3331024231180564. [PMID: 37293935 DOI: 10.1177/03331024231180564] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND This narrative review aims to discuss several common neurological and psychiatric disorders that show comorbidity with migraine. Not only can we gain pathophysiological insights by studying these disorders, comorbidities also have important implications for treating migraine patients in clinical practice. METHODS A literature search on PubMed and Embase was conducted with the keywords "comorbidity", "migraine disorders", "migraine with aura", "migraine without aura", "depression", "depressive disorders", "epilepsy", "stroke", "patent foramen ovale", "sleep wake disorders", "restless legs syndrome", "genetics", "therapeutics". RESULTS Several common neurological and psychiatric disorders show comorbidity with migraine. Major depression and migraine show bidirectional causality and have shared genetic factors. Dysregulation of both hypothalamic and thalamic pathways have been implicated as a possibly cause. The increased risk of ischaemic stroke in migraine likely involves spreading depolarizations. Epilepsy is not only bidirectionally related to migraine, but is also co-occurring in monogenic migraine syndromes. Neuronal hyperexcitability is an important overlapping mechanism between these conditions. Hypothalamic dysfunction is suggested as the underlying mechanism for comorbidity between sleep disorders and migraine and might explain altered circadian timing in migraine. CONCLUSION These comorbid conditions in migraine with distinct pathophysiological mechanisms have important implications for best treatment choices and may provide clues for future approaches.
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Affiliation(s)
- Nadine Pelzer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Irene de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Africk BN, Heiferman DM, Wozniak AW, Behzadi F, Ballard MS, Chazaro JM, Zsigray BM, Shanker RM, Reynolds MR, Anderson DE, Serrone JC. Angioarchitectural features amongst patients with unruptured brain arteriovenous malformations presenting with headache: findings from a single center retrospective review of 76 patients. J Headache Pain 2021; 22:122. [PMID: 34627140 PMCID: PMC8501699 DOI: 10.1186/s10194-021-01331-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Brain arteriovenous malformations (AVMs) consist of abnormal connections between arteries and veins via an interposing nidus. While hemorrhage is the most common presentation, unruptured AVMs can present with headaches, seizures, neurological deficits, or be found incidentally. It remains unclear as to what AVM characteristics contribute to pain generation amongst unruptured AVM patients with headaches. Methods To assess this relationship, the current study evaluates angiographic and clinical features amongst patients with unruptured brain AVMs presenting with headache. Loyola University Medical Center medical records were queried for diagnostic codes corresponding to AVMs. In patients with unruptured AVMs, we analyzed the correlation between the presenting symptom of headache and various demographic and angiographic features. Results Of the 144 AVMs treated at our institution between 1980 and 2017, 76 were unruptured and had sufficient clinical data available. Twenty-three presented with headaches, while 53 patients had other presenting symptoms. Patients presenting with headache were less likely to have venous stenosis compared to those with a non-headache presentation (13 % vs. 36 %, p = 0.044). Conclusions Our study suggests that the absence of venous stenosis may contribute to headache symptomatology. This serves as a basis for further study of correlations between AVM angioarchitecture and symptomatology to direct headache management in AVM patients.
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Affiliation(s)
- Benjamin N Africk
- Department of Pediatric Neurology, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, CA, 94304, Palo Alto, USA
| | | | - Amy W Wozniak
- Clinical Research Office, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Faraz Behzadi
- Loyola Stritch School of Medicine, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Matthew S Ballard
- Loyola Stritch School of Medicine, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Joshua M Chazaro
- Loyola Stritch School of Medicine, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Brandon M Zsigray
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Rachyl M Shanker
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Matthew R Reynolds
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Douglas E Anderson
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA.,Edward Hines Jr Veteran Administration Hospital, 5000 5th Avenue, IL, 60141, Hines, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA. .,Edward Hines Jr Veteran Administration Hospital, 5000 5th Avenue, IL, 60141, Hines, USA. .,Loyola University Medical Center, 2160 S 1st Avenue, IL, 60153, Maywood, USA.
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Thomsen AV, Sørensen MT, Ashina M, Hougaard A. Symptomatic migraine: A systematic review to establish a clinically important diagnostic entity. Headache 2021; 61:1180-1193. [PMID: 34254302 DOI: 10.1111/head.14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if a clinical presentation indistinguishable from migraine can occur due to an underlying condition or pathology, that is, "symptomatic migraine." BACKGROUND It is currently not clear whether migraine truly can be caused by an underlying condition or pathology. Characterization of the etiology and clinical features of possible symptomatic migraine is of significant clinical importance and further may help elucidate the pathophysiology of migraine. METHODS We devised operational diagnostic criteria for "symptomatic migraine" and "possible symptomatic migraine" requiring strong evidence for a causal relation between underlying cause and migraine symptoms adhering strictly to diagnostic criteria. PubMed was searched for case reports of symptomatic migraine from inception to March 2020. Only articles published in English or German were included. No restrictions were placed on study design. Relevant references in the articles were also included. Papers were systematically reviewed by two independent reviewers for detailed clinical features of migraine as well as the proposed underlying conditions and the effects of treatment of these conditions. RESULTS Our search retrieved 1726 items. After screening, 109 papers comprising 504 cases were reviewed in detail. Eleven patients with migraine with aura (MWA) fulfilled our working criteria for symptomatic migraine, and 39 patients fulfilled our criteria for possible symptomatic migraine. The most common etiologies of symptomatic migraine were arteriovenous malformations, carotid stenosis, dissection or aneurysm, brain infarctions, meningioma, and various intra-axial tumors. CONCLUSIONS Symptomatic MWA, indistinguishable from idiopathic MWA, may occur due to cortical lesions or microembolization. We found no clear evidence supporting the existence of symptomatic migraine without aura although we did identify possible cases. Our findings are limited by the available literature, and we suggest that prospective studies are needed.
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Affiliation(s)
- Andreas Vinther Thomsen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Morten Togo Sørensen
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Anders Hougaard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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6
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Unnithan AKA. Overview of the current concepts in the management of arteriovenous malformations of the brain. Postgrad Med J 2020; 96:212-220. [DOI: 10.1136/postgradmedj-2019-137202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/12/2019] [Accepted: 01/11/2020] [Indexed: 12/12/2022]
Abstract
BackgroundThere is a lack of consensus in the management of arteriovenous malformations (AVMs) of the brain since ARUBA (A Randomised trial of Unruptured Brain Arteriovenous malformations) trial showed that medical management is superior to interventional therapy in patients with unruptured brain AVMs. The treatment of brain AVM is associated with significant morbidity.Objectives and methodsA review was done to determine the behaviour of brain AVMs and analyse the risks and benefits of the available treatment options. A search was done in the literature for studies on brain AVMs. Descriptive analysis was also done.ResultsThe angiogenic factors such as vascular endothelial growth factor and inflammatory cytokines are involved in the growth of AVMs. Proteinases such as matrix metalloproteinase-9 contribute to the weakening and rupture of the nidus. The risk factors for haemorrhage are prior haemorrhage, deep and infratentorial AVM location, exclusive deep venous drainage and associated aneurysms. The advancements in operating microscope and surgical techniques have facilitated microsurgery. Stereotactic radiosurgery causes progressive vessel obliteration over 2–3 years. Endovascular embolisation can be done prior to microsurgery or radiosurgery and for palliation.ConclusionsSpetzler-Martin grades I and II have low surgical risks. The AVMs located in the cerebellum, subarachnoid cisterns and pial surfaces of the brainstem can be treated surgically. Radiosurgery is preferable for deep-seated AVMs. A combination of microsurgery, embolisation and radiosurgery is recommended for deep-seated and Spetzler-Martin grade III AVMs. Observation is recommended for grades IV and V.
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Abstract
Headache is a milestone in cerebrovascular disorders; indeed, it may represent the only symptom at onset or predominates over the other neurological features. Unfortunately, headache associated with cerebrovascular diseases lacks clear-cut characteristics as it may resemble a migraine attack, tension-type headache, or cluster headache; pain localization is also misleading along with drug (analgesic) response. However, in this review, we have analyzed and described the most common patterns of headache for different vascular disorders: it is known that headache due to subarachnoid aneurysmal hemorrhage presents peculiar characteristics (thunderclap, acute presentation, and high intensity), whereas in cerebral vasoconstriction syndrome, the short duration and the relapsing-remitting course of the thunderclap headache are key points for the diagnosis; in cervicocerebral artery, dissection pain is most commonly ipsilateral to the dissected vessel and is mainly perceived in the temporal area in case of carotid artery dissection and in the occipital area in case of vertebral artery dissection; in cerebral venous thrombosis, pain is often acute or subacute and severe; unfortunately, it may resemble a typical migraine attack or a tension-type episode; by the contrary, in primary angiitis of the central nervous system, pain is always subacute or chronic with mild-to-moderate intensity; finally, in brain arteriovenous shunts such as malformation or fistula, pain is more frequently a clue for disease complication such as hemorrhage from the malformation or thrombosis of the draining vein.
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Affiliation(s)
- Susanna Diamanti
- Department of Neurology, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Marco Longoni
- Department of Neurology and Stroke Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elio Clemente Agostoni
- Department of Neuroscience, Neurology and Stroke Unit, ASST GOM Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
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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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Bowden G, Cavaleri J, Kano H, Monaco E, Niranjan A, Flickinger J, Dade Lunsford L. Radiosurgery for Arteriovenous Malformations and the Impact on Headaches. Headache 2017; 57:737-745. [DOI: 10.1111/head.13055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 01/07/2017] [Accepted: 01/08/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Greg Bowden
- Center for Image-Guided Neurosurgery; University of Pittsburgh; Pittsburgh PA USA
- Department of Radiation Oncology; University of Pittsburgh; Pittsburgh PA USA
| | | | - Hideyuki Kano
- Center for Image-Guided Neurosurgery; University of Pittsburgh; Pittsburgh PA USA
- Department of Radiation Oncology; University of Pittsburgh; Pittsburgh PA USA
| | - Edward Monaco
- Center for Image-Guided Neurosurgery; University of Pittsburgh; Pittsburgh PA USA
- Department of Radiation Oncology; University of Pittsburgh; Pittsburgh PA USA
| | - Ajay Niranjan
- Center for Image-Guided Neurosurgery; University of Pittsburgh; Pittsburgh PA USA
- Department of Radiation Oncology; University of Pittsburgh; Pittsburgh PA USA
| | - John Flickinger
- Department of Radiation Oncology; University of Pittsburgh; Pittsburgh PA USA
| | - L. Dade Lunsford
- Center for Image-Guided Neurosurgery; University of Pittsburgh; Pittsburgh PA USA
- Department of Radiation Oncology; University of Pittsburgh; Pittsburgh PA USA
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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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11
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Samanta D. Sporadic hemiplegic migraine and giant tumefactive perivascular space: Is there an association? Acta Neurol Belg 2016; 116:619-620. [PMID: 26696413 DOI: 10.1007/s13760-015-0585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Debopam Samanta
- Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR, 72202, USA.
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12
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Relief of epilepsy and headache and quality of life after microsurgical treatment of unruptured brain AVM—audit of a single-center series and comprehensive review of the literature. Neurosurg Rev 2016; 40:59-65. [DOI: 10.1007/s10143-016-0750-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/29/2016] [Accepted: 04/09/2016] [Indexed: 10/21/2022]
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Abstract
In a recent trial limited to arteriovenous malformations discovered not to have bled, medical management was superior to medical management plus intervention. The trial was halted after 226 randomizations and a mean follow-up of 3.3 years owing to a disparity favoring the medical arm. Eligible patients were selected as suitable for lesion eradication. The initial sample size of 800 and follow-up plans for a mean of 7 years were lowered and shortened, respectively, by the outcome data. An application for extended follow-up was given poor priority scores owing to estimations that the disparities in outcomes would not change significantly.
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Affiliation(s)
- J P Mohr
- Department of Neurology, Doris & Stanley Tananbaum Stroke Center, Neurological Institute, Columbia University Medical Center, 710 West 168th Street, New York, NY 10032, USA.
| | - Shadi Yaghi
- Department of Neurology, Doris & Stanley Tananbaum Stroke Center, Neurological Institute, Columbia University Medical Center, 710 West 168th Street, New York, NY 10032, USA
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14
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Dasenbrock HH, Du R. Presentation of Cerebral Arteriovenous Malformations. World Neurosurg 2016; 89:694-6. [PMID: 26739906 DOI: 10.1016/j.wneu.2015.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Hormuzdiyar H Dasenbrock
- Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rose Du
- Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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15
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Ellis JA, Mejia Munne JC, Lavine SD, Meyers PM, Connolly ES, Solomon RA. Arteriovenous malformations and headache. J Clin Neurosci 2016; 23:38-43. [DOI: 10.1016/j.jocn.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 08/11/2015] [Indexed: 01/03/2023]
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Affiliation(s)
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Pasquale Parisi
- Child Neurology & Paediatric Headache Centre, Chair of Paediatrics, NESMOS Dpt, University of Rome 'Sapienza', Faculty of Medicine & Psychology, c/o "S. Andrea" Hospital, Rome, Italy
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Abstract
BACKGROUND Migraine, particularly with aura, increases the risk for ischemic stroke, at least in a subset of patients. The underlying mechanisms are poorly understood and probably multifactorial. METHODS We carried out an extended literature review of experimental and clinical evidence supporting the association between migraine and ischemic stroke to identify potential mechanisms that can explain the association. RESULTS Observational, imaging and genetic evidence support a link between migraine and ischemic stroke. Based on clinical and experimental data, we propose mechanistic hypotheses to explain the link, such as microembolic triggers of migraine and enhanced sensitivity to ischemic injury in migraineurs. DISCUSSION We discuss the possible practical implications of clinical and experimental data, such as aggressive risk factor screening and management, stroke prophylaxis and specific acute stroke management in migraineurs. However, evidence from prospective clinical trials is required before modifying the practice in this patient population.
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Affiliation(s)
- Jerome Mawet
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Emergency Headache Center, Lariboisiere Hospital, Assistance Publique-Hopitaux de Paris, France DHU NeuroVasc, France
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, France University of Bordeaux, College of Health Sciences, France Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA
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Massano D, Julliand S, Kanagarajah L, Gautier M, Vizeneux A, Elmaleh M, Alison M, Lejay E, Romanello S, Teisseyre L, Delanoe C, Titomanlio L. Headache with focal neurologic signs in children at the emergency department. J Pediatr 2014; 165:376-82. [PMID: 24928695 DOI: 10.1016/j.jpeds.2014.04.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/18/2014] [Accepted: 04/29/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify predictors of secondary headache in children consulting at the pediatric emergency department (ED) for headache with a focal neurologic deficit. STUDY DESIGN In this prospective cohort study, we enrolled children aged 6-18 years presenting to the ED of a tertiary care hospital with moderate to severe headache and focal neurologic deficit. Enrollment took place between March 2009 and February 2012. Children with a history of trauma, fever, or neurosurgical intervention were excluded from the study. The final diagnosis was made after 1 year of follow-up. Our primary aim was to identify any differences in the frequency of clinical signs between children with a final diagnosis of primary headache and those with a final diagnosis of secondary headache. RESULTS Of the 101 patients included in the study, 66% received a final diagnosis of primary headache (94% migraine with aura), and 34% received a final diagnosis of secondary headache (76.5% focal epilepsy). On multivariate analysis, children with bilateral localization of pain had a higher likelihood (aOR, 8.6; 95% CI, 3.2-23.2; P<.001) of having secondary headache. CONCLUSION Among children presenting to the ED with focal neurologic deficits, a bilateral headache location was associated with higher odds of having a secondary cause of headache. Additional longitudinal studies are needed to investigate whether our data can aid management in the ED setting.
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Affiliation(s)
- Davide Massano
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Sebastien Julliand
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Lakshmi Kanagarajah
- Department of Radiology, Basildon University Hospital, Essex, United Kingdom
| | - Maxime Gautier
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Audrey Vizeneux
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Monique Elmaleh
- Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Marianne Alison
- Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Emilie Lejay
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Silvia Romanello
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Laurence Teisseyre
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Catherine Delanoe
- Neurophysiology Unit, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Luigi Titomanlio
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
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19
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Galletti F, Costa C, Cupini LM, Eusebi P, Hamam M, Caputo N, Siliquini S, Conti C, Moschini E, Lunardi P, Carletti S, Calabresi P. Brain arteriovenous malformations and seizures: an Italian study. J Neurol Neurosurg Psychiatry 2014; 85:284-8. [PMID: 23853138 DOI: 10.1136/jnnp-2013-305123] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate seizures as first clinical manifestation of brain arteriovenous malformations (AVMs), in relation to angioarchitectural features of these vascular anomalies. METHODS We performed a prospective observational study, collecting records of patients with AVMs consecutively admitted to the Neurological and Neurosurgery Units of Perugia University and to the Neurosurgery Unit of Terni Hospital, during a 10-year period (1 January 2002 to 1 June 2012). Two groups of patients, with or without seizures as AVM first presentation, were analysed to identify differences in demographic and angiographic features. A multivariate logistic regression model was also developed. RESULTS We examined 101 patients with AVMs, 55 male and 46 female. Seizures were the initial clinical manifestation in 31 (30.7%) patients. We found a significant difference (p<0.05) between two groups of patients, with or without seizures as AVM first presentation concerning location, side, topography and venous drainage. A multivariate logistic regression model showed that clinical presentation with seizures was correlated with a location in the temporal and frontal lobes, and with a superficial topography. The strongest association (OR 3.48; 95% CI 1.77 to 6.85) was observed between seizures and AVM location in the temporal lobe. CONCLUSIONS Vascular remodelling and haemodynamic changes of AVMs might create conditions for epileptogenesis. However, here we show that malformations with specific angiographic characteristics are more likely to be associated with seizures as first clinical presentation. Location is the most important feature related to epilepsy and in particular the temporal lobe might play a crucial role in the occurrence of seizure.
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Affiliation(s)
- F Galletti
- Clinica Neurologica, Università degli Studi di Perugia, , Perugia, Italy
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New and Emerging Interventional Neuroradiologic Techniques for Neuro-Opthalmologic Disorders. J Neuroophthalmol 2013; 33:282-95. [DOI: 10.1097/wno.0b013e3182a319e7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quality of life and psychological impact in adult patients with hemorrhagic moyamoya disease who received no surgical revascularization. J Neurol Sci 2013; 328:32-6. [DOI: 10.1016/j.jns.2013.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/22/2013] [Accepted: 02/13/2013] [Indexed: 11/19/2022]
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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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