title: Occipital arteriovenous malformations and migraine.
abstract: BACKGROUND
  Headache has been reported to be the first clinical presentation in several patients with cerebral arteriovenous malformations (AVMs). Headache associated with AVMs often shows characteristics of migraine with and without aura. Angiographic characteristics of AVMs, such as their location, could determine the 'migraine-like' features of attacks.
  
  
  METHODS
  We performed an observational study of the clinical and angiographic characteristics of a cohort of 40 consecutive patients with AVMs who had been admitted to our institute for endovascular embolization over a 4-year period. Headache was characterized according to ICHD-II criteria. The relationship between headaches and the angioarchitectural features of AVMs was also analysed.
  
  
  RESULTS
  Migraine-like headache was the first clinical manifestation in 22.5% of patients. The location of the malformation was significantly associated with migraine-like presentation (p=0.03) and the occipital lobe was the predominant site.
  
  
  CONCLUSIONS
  An occipital location may be linked with spreading depression, a pathogenic mechanism of migraine. Headache associated with arteriovenous malformations in the occipital lobe, although secondary in nature, could have clinical features similar to migraine.
authors.affiliation: Clinica Neurologica, Università degli Studi di Perugia, Ospedale Santa Maria della Misericordia, S Andrea delle Fratte, Perugia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Galletti
authors.forename: Paola
authors.initials: P
authors.lastname: Sarchielli
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hamam
authors.forename: Cinzia
authors.initials: C
authors.lastname: Costa
authors.forename: Letizia M
authors.initials: LM
authors.lastname: Cupini
authors.forename: Gabriela
authors.initials: G
authors.lastname: Cardaioli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Belcastro
authors.forename: Paolo
authors.initials: P
authors.lastname: Eusebi
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Lunardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabresi
mesh_terms: D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications* / Q000628:therapy; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000209:etiology* / Q000473:pathology; D009778:Occipital Lobe / Q000098:blood supply* / Q000473:pathology*; D055815:Young Adult