title: Headache during cryoballoon ablation for atrial fibrillation.
abstract: OBJECTIVE
  Headache has been reported to occur during cryoballoon ablation for atrial fibrillation (AF). No study has systematically analysed this phenomenon.
  
  
  RESULTS
  Twenty consecutive patients with symptomatic AF underwent cryoballoon ablation without sedation. Headache was evaluated before, during, and after the first cryoapplication in every pulmonary vein (PV) using a visual representation of a head for location of the headache, a numerical rating scale (NRS) for measuring pain intensity and the short-form McGill pain questionnaire (MPQ) for qualitative analysis of pain. The order in which the PVs were ablated was randomized. Sixteen (80%) patients perceived mainly frontal headache during cryoablation. The overall NRS scores were significantly higher during (5.1 ± 1.7), compared with before (2.7 ± 1.4), and after (3.5 ± 2.2) a cryoapplication (P < 0.05). The NRS score was significantly higher during ablation of the first PV. The intensity of the perceived headache was not related to the temperature reached 150 s after initiation of a cryoapplication (P = 0.81). Of the MPQ, three sensory adjectives and one affective adjective averaged between scores 1 and 2, representing mild-to-moderate severity of pain.
  
  
  CONCLUSIONS
  The majority of patients treated by balloon cryoablation experienced headache during a cryoapplication. There was no correlation between the temperature reached during a cryoballoon freeze and the intensity of the headache. Cryoballoon ablation of the first PV was significantly more painful than the remaining PVs.
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands l.pison@mumc.nl.
authors.forename: Laurent
authors.initials: L
authors.lastname: Pison
authors.affiliation: Department of Psychology, KU Leuven, Leuven, Belgium.
authors.forename: Pim
authors.initials: P
authors.lastname: Peeters
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Blaauw
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: Vernooy
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Philippens
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Crijns
authors.affiliation: Department of Psychology, KU Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vlaeyen
authors.affiliation: Headache Research Unit, University Department of Neurology, CHR de la Citadelle, Liège, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Schoenen
authors.affiliation: Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
authors.forename: Carl
authors.initials: C
authors.lastname: Timmermans
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D015331:Cohort Studies; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*
keywords: Ablation; Atrial fibrillation; Cryoballoon; Headache