Aspirin use and platelet aggregation in ischemic onset-type pediatric moyamoya patients with intractable headaches (moya-ache)

Aihara, Yasuo; Kashiwase, Shinobu; Chiba, Kentaro; Yamaguchi, Koji; Okada, Yoshikazu; Kimura, Toshimi; Kawamata, Takakazu

doi:10.1007/s00381-020-04991-y

Cited by 10 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Antiplatelet therapy is often used to prevent ischemic stroke and transient ischemic attack in patients with MMD. As previously stated, a recent retrospective study also demonstrated the benefit of aspirin for headache in patients with MMD (30). Of note, other studies have suggested the potential role of aspirin (49)(50)(51), clopidogrel (52,53), prasugrel, and ticagrelor (54) in migraine prevention (55)(56)(57).…”

Section: Medical Management Of Headache In Patients With MMDmentioning

confidence: 69%

“…Additionally, the vascular endothelial damage in MMD and related collagen exposure could also promote platelet aggregation, which not only correlates with the risk of ischemic infarct but also was recently shown to correlate with intractable headache in patients with MMD (30). The theory is supported by study results showing that the platelet aggregation test value is associated with a higher risk of developing intractable headache in pediatric MMD patients, that the risk of developing headache decreased with aspirin administration, and 85% of all patients in the study with intractable headaches improved with aspirin, a medication that suppresses collagen-mediated platelet aggregation (30). Given the small sample size (35 patients), more studies are needed to explore the role of platelet aggregation and headache in MMD.…”

Section: Pathophysiology Of Headache In Patients With MMDmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation and treatment of headache associated with moyamoya disease – a narrative review

et al. 2021

View full text Add to dashboard Cite

Background Headache in patients with moyamoya disease is an under-addressed topic in the medical literature. Delay in the diagnosis of moyamoya disease or inappropriate treatment of headache could lead to devastating cerebrovascular outcome. With the evolving understanding of moyamoya disease, migraine pathophysiology, and various migraine-specific medications that have become available, it is crucial to provide an updated overview on this topic. Methods We searched PubMed for keywords including moyamoya disease, moyamoya syndrome, headache in moyamoya, surgical revascularization, surgical bypass, migraine and moyamoya, and calcitonin gene-related peptide (CGRP). We summarized the literature and provide a comprehensive review of the headache presentation, possible mechanisms, the impact of various surgical revascularizations on headache in patients with moyamoya disease, and the medical management of headache incorporating novel migraine-specific treatments. Results and conclusion: The most common headache phenotype is migraine; tension-type headache, hemiplegic migraine, and cluster headache have also been reported. Most patients experience improvement of headache after surgical revascularization, though some patients report worsening, or new-onset headache after surgery. Given the complexity of moyamoya disease, careful consideration of different types of medical therapy for headache is necessary to improve the quality of life while not increasing the risk of adverse cerebrovascular events. More prospective studies are warranted to better understand and manage headache in patients with moyamoya disease.

show abstract

Section: Medical Management Of Headache In Patients With MMDmentioning

confidence: 69%

Section: Pathophysiology Of Headache In Patients With MMDmentioning

confidence: 99%

Evaluation and treatment of headache associated with moyamoya disease – a narrative review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…A severe headache when waking up is specific to ischemic pediatric patients with MMD. 37 However, the headaches in these patients were persistent, occurring not only in the morning, but they were temporarily enhanced when the patients were restless and crying. Headaches have often been observed with postoperative hyperperfusion of adult patients with MMD, but they are rare in our experience with pediatric cases.…”

Section: Discussionmentioning

confidence: 90%

Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series

Araki

Mamiya

Fujita

et al. 2022

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND Symptomatic hyperperfusion after cerebral revascularization for pediatric moyamoya disease (MMD) is a rare phenomenon. The authors report a series of patients with this condition. OBSERVATIONS In all three patients in this case series, the combined revascularization was on the left side, the patency of bypass grafts was confirmed after surgery, and focal hyperemia around the anastomotic site was observed on single photon emission computed tomography (SPECT). On the first to eighth days after surgery, all of the patients developed neurological manifestations, including motor aphasia, cheiro-oral syndrome, motor weakness of their right upper limbs, and severe headaches. These symptoms disappeared completely approximately 2 weeks after surgery, and all patients were discharged from the hospital. Quantitative SPECT was performed to determine the proportional change in cerebral blood flow (ΔRCBF) (to ipsilateral cerebellar ratio (denoted ΔRCBF) in the region of interest around the anastomoses, and the mean value was 1.34 (range, 1.29–1.41). LESSONS This rare condition, which develops soon after surgery, requires an accurate diagnosis by SPECT. One indicator is that the ΔRCBF has risen to 1.3 or higher. Subsequently, strategic blood pressure treatment and fluid management could prevent the development of hemorrhagic stroke.

show abstract

“…Caution in the use of NSAIDs derives from their antiplatelet effect (potentially increasing the bleeding risk) and their vasoactive properties (inducing vasoconstriction). On the contrary, some experiences in ischemic onset-type pediatric moyamoya patients who experience headaches and aspirin administration demonstrated effectiveness in alleviating headaches by inhibiting platelet activation [92]. Vasoconstriction could also be induced by triptans (this phenomenon has also been shown in the STA).…”

Section: Headache Managementmentioning

confidence: 99%

Clinical Management of Moyamoya Patients

Canavero

Vetrano

Zedde

et al. 2021

JCM

View full text Add to dashboard Cite

Moyamoya angiopathy (MMA) is a peculiar cerebrovascular condition characterized by progressive steno-occlusion of the terminal part of the internal carotid arteries (ICAs) and their proximal branches, associated with the development of a network of fragile collateral vessels at the base of the brain. The diagnosis is essentially made by radiological angiographic techniques. MMA is often idiopathic (moyamoya disease-MMD); conversely, it can be associated with acquired or hereditary conditions (moyamoya Syndrome-MMS); however, the pathophysiology underlying either MMD or MMS has not been fully elucidated to date, and this poor knowledge reflects uncertainties and heterogeneity in patient management. MMD and MMS also have similar clinical expressions, including, above all, ischemic and hemorrhagic strokes, then headaches, seizures, cognitive impairment, and movement disorders. The available treatment strategies are currently shared between idiopathic MMD and MMS, including pharmacological and surgical stroke prevention treatments and symptomatic drugs. No pharmacological treatment able to reverse the progressive disappearance of the ICAs has been found to date in both idiopathic and syndromic cases. Antithrombotic agents are usually prescribed in ischemic MMA, although the coexisting hemorrhagic risk should be considered. Surgical revascularization techniques, which are currently the best available treatment in symptomatic MMA, are associated with good long-term outcomes and reduced ischemic and hemorrhagic risks. Given the lack of dedicated randomized clinical trials, current treatment is mainly based on observational studies and physicians’ and surgeons’ expertise.

show abstract

Aspirin use and platelet aggregation in ischemic onset-type pediatric moyamoya patients with intractable headaches (moya-ache)

Cited by 10 publications

References 27 publications

Evaluation and treatment of headache associated with moyamoya disease – a narrative review

Evaluation and treatment of headache associated with moyamoya disease – a narrative review

Symptomatic hyperperfusion after combined revascularization surgery in patients with pediatric moyamoya disease: patient series

Clinical Management of Moyamoya Patients

Contact Info

Product

Resources

About