Headache Following Intracranial Neuroendovascular Procedures

Cleveland Clinic Neurological Institute-Neurology, Center for Headache and Pain, Center for Regional Neurology, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Headache The Journal of Head and Face Pain (Impact Factor: 2.71). 12/2011; 52(5):739-48. DOI: 10.1111/j.1526-4610.2011.02059.x
Source: PubMed


Predicting who will develop post-procedure headache (PPH) following intracranial endovascular procedures (IEPs) would be clinically useful and potentially could assist in reducing the excessive diagnostic testing so often obtained in these patients. Although limited safety data exist, the use of triptans or dihydroergotamine (DHE) often raise concern when used with pre/post-coiled aneurysms. We sought to determine risk factors for PPH following IEP, to evaluate the utility of diagnostic testing in patients with post-coil acute headache (HA), and to record whether triptans and DHE have been used safely in this clinical setting.
We conducted a retrospective chart review of adult patients undergoing IEPs. Bivariate analyses were conducted to compare patients who did and did not develop PPH.
We reviewed records pertaining to 372 patients, of whom 263 underwent intracranial coil embolizations, 21 acrylic glue embolizations, and 88 stent placements. PPH occurred in 72% of coil patients, 33% of glue patients, and 14% of stent patients. Significant risk factors for post-coil HA were female gender, any pre-coil HA history, smoking, and anxiety/depression. A pre-stent history of HA exceeding 1 year's duration, and smoking were risk factors for post-stent HA. A pre-glue history of HA exceeding 1 year was the only risk factor for post-glue HA. In the small subgroup available for study, treatment with triptans or DHE was not associated with adverse events in pre/post-coiled aneurysms. Diagnostic testing was low yield.
Occurrence of PPH was common after IEPs and especially so with coiling and in women, smokers, and those with anxiety/depression, and was often of longer duration than allowed by current International Classification of Headache Disorders-II criteria. The yield of diagnostic testing was low, and in a small subgroup treatment with triptans or DHE did not cause adverse events in pre/post-coiled aneurysms. Prospective studies are needed to confirm these findings.

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Available from: Eric P Baron, May 31, 2015
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    • "These and other studies have also remarked upon a small subset of patients who experienced worsening of their headaches in the absence of a complication. This group was the subject of a retrospective study by Baron et al. [15] looking at the development of headache following a variety of endovascular procedures. They also found an initial reduction of headaches following treatment of the vascular malformation. "
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    • "Potential predictors for the absence of headache improvement following aneurysm treatment were: having migraine prior to treatment, having more severe headaches prior to treatment, stent-assisted coiling and higher pretreatment trait anxiety. Baron EP et al. (2011) found that stent-assisted coiling may provoke development of post-procedural headache [26]. "
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