Headache and endovascular procedures

Biase, Stefano de; Longoni, Marco; Gigli, Gian Luigi; Agostoni, Elio

doi:10.1007/s10072-017-2880-2

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…These features define the three subtypes of headache attributed to an intracranial endarterial procedure recognized in the ICDH-3 classification. Mainly in terms of headache duration, current criteria are confusing, possibly as intracranial endarterial procedures today encompass a variety of procedures, for example, angioplasty, embolization, stent placement, etc., which depend on the indication to be treated [2][3][4][5][6][7][8]. Endovascular mechanical thrombectomy is the most efficacious treatment for ischemic stroke secondary to occlusion of brain arterial circulation [9][10][11][12][13][14].…”

Section: Open Accessmentioning

confidence: 99%

De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study

et al. 2022

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Background and aim Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke. Methods Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire. Results One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8–35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours. Conclusions Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity.

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Section: Open Accessmentioning

confidence: 99%

De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study

et al. 2022

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“…Endovascular treatment (EVT) of vascular diseases like ischaemic stroke or aneurysms are common therapeutical options which are practiced widely nowadays 1 2. Even though the success rates are high, postinterventional headache—mostly described as pressure-like or stabbing—occurs frequently 3–5. Risk factors associated with the development of a postinterventional headache comprise female sex, therapeutical procedures, smoking, anxiety or depression and previous headache 3 4.…”

Section: Introductionmentioning

confidence: 99%

Development of a cluster-like headache after a stent-assisted implantation of an endovascular WEB device

2022

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After interdisciplinary consent, a male patient in his 50s received endovascular treatment of an innocent supraophthalmic aneurysm of the internal carotid artery with a WEB (woven endo bridge) device and stenting. In the medical history, a migraine with aura was reported. A week after intervention, the patient developed an ipsilateral cluster-like headache responsive to classical interventions. Inflammation of the carotid wall near the stent was demonstrated to be associated with the headaches and was responsive to steroid treatment.The presented case demonstrates that postinterventional headache comprises more headache entities than the often reported migraine and tension-type headache with a considerable impact on the patients’ quality of life. The case supports the vascular hypothesis of cluster headache pathophysiology, potentially contradicting current models and assumptions.

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Acute Headache Management for Patients with Subarachnoid Hemorrhage: An International Survey of Health Care Providers

et al. 2022

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Background: Severe headaches are common after subarachnoid hemorrhage (SAH). Guidelines recommend treatment with acetaminophen and opioids, but patient data show that headaches often persist despite multimodal treatment approaches. Considering an overall slim body of data for a common complaint affecting SAH patients during their intensive care stay, we set out to assess practice patterns in headache management among clinicians who treat patients with SAH.Methods: We conducted an international cross-sectional study through a 37-question web-based survey distributed to members of 5 professional societies relevant to intensive and neurocritical care from 11/2021-1/2022. Responses were characterized through descriptive analyses; Fisher's exact test was used to test associations.Results: Of 516 responses, 329/497 (66%) were from North America and 121/497 (24%) from Europe. 379/435 (87%) reported headache as major management concern for SAH patients. Intensive-care-teams were primarily responsible for analgesia during hospitalization (249/435, 57%), while responsibility shifted to neurosurgery at discharge (233/501, 47%). Most used medications were acetaminophen (90%), opioids (66%), corticosteroids (28%) and antiseizure medications (28%). Opioids or medication combinations including opioids were most frequently perceived as most effective, by 169/433 (39%, predominantly intensivists), followed by corticosteroids or combinations with corticosteroids (96/433, 22%, predominantly neurologists). Of medications prescribed at discharge, acetaminophen was most common (303/381, 80%), followed by opioids (175/381 [46%]), and antiseizure medications (173/381, 45%). Opioids during hospitalization were signi cantly more prescribed by intensivists, by providers managing higher numbers of SAH patients, and in Europe. At discharge, opioids were more frequently prescribed in North America. 299/435 (69%) indicated no change in prescription practice of opioids with the opioid crisis. Additional differences in prescription patterns between continents and providers, and inpatient versus discharge were found.Conclusions: Post-SAH headache in the intensive care setting is a major clinical concern. Analgesia heavily relies on opioids both in utilization and in perception of e cacy, with no reported change in prescription patterns for opioids for most providers despite the signi cant drawbacks of opioids.Responsibility for analgesia shifts between hospitalization and discharge. International and providerrelated differences are evident. Novel treatment strategies and alignment of prescription between providers are urgently needed.

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Headache and endovascular procedures

Cited by 4 publications

References 26 publications

De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study

De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study

Development of a cluster-like headache after a stent-assisted implantation of an endovascular WEB device

Acute Headache Management for Patients with Subarachnoid Hemorrhage: An International Survey of Health Care Providers

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