Headaches During Intracranial Endovascular Procedures: A Possible Model of Vascular Headache

Abstract

We report a series of 11 patients who developed headaches during intracranial endovascular procedures performed for the treatment of arteriovenous malformations (10 cases) or aneurysms (1 case). Headache was precipitated either by balloon inflation (3 cases) or by embolization (8 cases), and had a very constant pattern. In all cases the pain started suddenly, reaching maximum intensity at once. Headache was focal, unilateral, ipsilateral to the occluded artery, nonthrobbing and short-lasting (usually less than 10 minutes). It was not associated with gastrointestinal, autonomic, or aura-like symptoms. Headache localization depended upon the catheterized artery, being constant for each of the major vascular territories. Yet, in all patients pain was felt in the cutaneous territory of the ophthalmic division of the trigeminal nerve. The occurrence of headache was not associated with cortical deficit nor cortical irritation (assessed both clinically and by the EEG) and therefore seems to be directly related to the stimulation of the arterial wall. This type of pain can be used as a model of pure vascular headache. Its study can contribute not only to understand the pattern of intracranial vascular innervation but also to understand or to refute the vascular components of migraine.

Headaches during angiography and endovascular procedures

“…This description is similar to previous reports of headache during embolization procedures [7,9,10] and corresponds to the ICHD-II [4] diagnostic criteria for headache attributed to intracranial endovascular procedures (code 6.5.4). Four patients in our series suffered such a headache attack during embolization sessions related to injecting cyanoacrylate or balloon inflation.…”

“…The occurrence of headache during cranial embolization has been attributed to vessel distension occurring with balloon inflation, which stimulates pain receptors in the vessel wall, producing focal areas of referred pain [7,9,10]. Theoretically, it can also occur with contrast injection, if the pressure within the vessel is enough to reach the threshold of mechanical stimulation of pain receptors.…”

Follow-Up of Patients with History of Cervical Artery Dissection

“…Although headaches reported after en dovascular procedures are usually very acute [32], they may show similar mechanisms as post-CAD headache: mechanical stimulation of the arterial wall (stretching, distorsion), local inflammatory changes and vasodilata tion in collaterals. Olesen et al [33] suggested that throm boembolic ischemia may also trigger an attack of migraine in migraine patients and also in nonmigraine patients; they suggested that such acute episodes may be due to the effect of a borderline perfusion which lowers the threshold for developing migraine aura with or without headache [33]: this mechanism is unlikely in our patients, because none of them had an aura.…”

The Characteristics and Risk Factors of Headache Development after the Coil Embolization of an Unruptured Aneurysm

“…[7][8][9][10][11][12][13][14][15][16] This dilation can be induced by mechanical forces as well as chemicals. It is well known that many patients experience a headache during angioplasty of the intracranial artery, 7,8,13 and a similar mechanism may apply to headache development after coil embolization. During and after coiling, if coil packing is enough to entrap blood and to not permit free blood flow, thrombosis can be induced in the coil frame and aneurysmal sac.…”