Headache and Treatment of Unruptured Intracranial Aneurysms

Arena JE1, Hawkes MA2, Farez MF1, Pertierra L1, Kohler AA1, Marrodán M1, Benito D3, Goicochea MT1, Miranda JC3, Ameriso SF4.

 

Key points:

  • To describe headache characteristics in patients diagnosed with an unruptured intracranial aneurysm (UIA) during workup of an otherwise primary headache.

  • To determine clinical features that should raise suspicion of a possible underlying UIA.

  • To assess headache changes after UIA treatment.

  • To find potential predictors of favorable outcome.

Despite several studies have mentioned the presence of headache (cluster headache, hemicrania continua, and migraine) in subjects with UIAs, in 18%-34% of cases, in general practice chronic primary headache is not usually considered a clinical manifestation of UIAs; for this reason, actually the decision to treat an UIA is based on the preference of the patient and the primary physician. In this paper, published online February 07, 2017 in the Journal of Stroke and Cerebrovascular Diseases, the study authors assessed headache characteristics, in patients with UIA, and any changes after treatment.

Arena J.E., Maximiliano A., Hawkes M.A. et al. identified patients undergoing treatment for UIA (both endovascular and surgical) between 2002 and 2013 and selected those with headache in which the UIA was determined to be the cause (according to International Classification of Headache Disorders, 3rd edition [ICHD-III], criteria). Thunderclap headache were excluded from the study because it could also be a manifestation of subarachnoid hemorrhage or a “sentinel headache” for early bleeding of the aneurysm.

Patients informations

Authors demonstrated a robust beneficial effect of treatment of UIA on prior referred headache. They did a logistic multivariable study, comparing patients, headache and aneurysm characteristics in the group with improvement versus the group without improvement: interestingly, only higher headache frequency was associated with a greater odd of improvement after treatment. The frequency of headaches decreased after treatment in 81% of the patients, and self-reported headache intensity improvement was present in 76% of the patients.

Authors also demonstrated that aneurysm size and type of treatment received did not influence the outcome of the headache.

In conclusion:

  •  Migraine without aura is frequent in patients with UIA .

  •  Patients suffering from migraine with onset later in life appear to be at higher risk of harboring a UIA .

  •  Higher frequency of headache episodes was associated with greater odds of improvement .

Reference

Arena JE, Hawkes MA, Farez MF, Pertierra L, Kohler AA, Marrodán M, Benito D, Goicochea MT, Miranda JC, Ameriso SF. Headache and Treatment of Unruptured Intracranial Aneurysms. J Stroke Cerebrovasc Dis. 2017 Feb 7. pii: S1052-057(16)30634-6. doi: 10.1016/j.jstrokecerebrovasdis.2016.12.026. [Epub ahead of print]

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