Major Finding: Postprocedural headaches occurred in 72% of patients who underwent intracranial endovascular aneurysmal coiling.
Data Source: A retrospective chart review of 263 patients who underwent intracranial endovascular aneurysmal coiling.
Disclosures: Dr. Baron had no relevant disclosures.
CARLSBAD, CALIF. – Nearly three quarters of patients had an acute headache after endovascular coiling of cerebral aneurysms in a review of a 3-year period at a single center.
The postprocedural headaches occurred significantly more often in women, smokers, and patients with a preprocedural history of headache or anxiety and depression, according to Dr. Eric P. Baron.
“Optimized risk-factor management prior to coiling may help decrease the occurrence of postcoiling headache.
“The presence of these risk factors may also help predict those more likely to complain of postcoiling headache and help guide clinical decisions of neuroimaging or other testing.
However, good clinical judgment should always supersede in these decisions,” said Dr. Baron, a neurologist who is affiliated with the Center for Headache and Pain at the Cleveland Clinic Neurological Institute.
Although urgent diagnostic procedures to evaluate postcoiling headaches proved unhelpful, Dr. Baron and his colleagues found that triptans or dihydroergotamine (DHE) safely treated both pre- and postcoiling headaches in a small group of migraineurs.
Headache was also common in aneurysm patients before coiling, both for those who underwent emergent and elective coiling. Coiling resolved headaches in a small proportion of these patients, he noted.
“Triptans and DHE may not necessarily be a contraindication in all migraineurs with pre- and postcoiling headache, and aneurysmal coiling may actually resolve preexisting headaches in a select group of patients, but at this time, predicting that group of patients is unclear.
“Ultimately, further prospective studies are necessary to better evaluate all of these trends,” Dr. Baron said.
The investigators reviewed the records of 263 adult patients (200 women and 63 men) who underwent either emergent or elective intracranial endovascular coiling for aneurysm treatment between July 2006 and June 2009.
Patients with skull defects, ventricular shunt placement, cranial trauma, extracranial procedures, and intracranial neoplasms or infections were excluded.
Most (76%) of the aneurysms were located in the anterior circulation; 24% were in the posterior circulation. A headache developed following coiling in 189 (72%) patients.
A significantly greater percentage of patients with headaches were women (81%).
More women overall also developed postcoiling headache than did men (77% vs. 57%).
Smoking was a significant risk factor for postprocedural headache. A majority of patients (56%) with postcoiling headaches were smokers, and 85% of all smokers developed postcoiling headache.
The incidence of postcoiling headache was higher in women who smoked than it was in men who smoked (90% vs. 70%, respectively).
Postcoiling headaches also affected 86% of patients with either anxiety or depression.
Postprocedural headaches were significantly more likely to occur among patients who experienced headaches prior to undergoing endovascular coiling, regardless of the length of time they had had them, the review found.
Headache complaints spurred 118 urgent diagnostic procedures, including 69 noncontrast CTs, 7 CT angiograms, 29 MR scans (including angiography and venography), 5 cerebral angiograms, and 8 lumbar punctures. All were negative for an acute process that was felt to be the cause of the headache.
“Excessive diagnostic testing is often obtained in patients with prior intracranial endovascular coiling. Results are frequently low yield and may lead to unnecessary risks and costs,” Dr. Baron said.
Pre- and postcoiled aneurysms often are considered a contraindication for the use of triptans or ergots such as DHE to treat headaches in migraineurs, according to Dr. Baron. But in this cohort, triptans were used without incident in 10 cases before coiling and in 10 cases after coiling; DHE was used for one patient after coiling.
Headaches resolved after coiling in a small proportion of patients, including 27% of patients who underwent emergency coiling, 16% of patients who had headaches for less than 1 year before elective coiling, and 11% of patients who had headaches for 1 year or longer before elective coiling.