title: Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy.
abstract: BACKGROUND
  Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral arteriovenous malformations (AVMs) and aneurysms.
  
  
  METHODS
  A total of 324 patients underwent EVT treatment for aneurysms and AVMs at the Danish National Hospital from January 2012 to December 2014. We applied strict exclusion criteria in order to minimize the effect of other factors on headache occurrence, e.g., craniotomy. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire. Headaches were classified according to ICHD-III beta criteria.
  
  
  RESULTS
  The 59 patients underwent treatment of aneurysms (n = 43), cranial dural fistulas (n = 11), and AVMs (n = 5). There was a significant increase in overall headache (p = 0.017) and tension-type headache (TTH) (p = 0.012) within the first 3 months after EVT compared to 1 month before EVT. However, at interview time (median 2.5 years post-EVT), the increase in overall headache, migraine, and tension-type headache was not statistically significant. A minority of patients experienced headaches for the first time within 3 months of their EVT (migraine 4, TTH 10). At interview time, 50 % of these new headaches still persisted.
  
  
  CONCLUSIONS
  Our results suggest a temporary increase in headache in the first 3 months after EVT, which normalizes over time. Clinicians may use this knowledge to better inform their patients of functional outcomes after their EVT procedure.
authors.affiliation: Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600, Denmark. sabrina.khan@regionh.dk.
authors.forename: Sabrina
authors.identifier: http://orcid.org/0000-0002-0953-5701
authors.initials: S
authors.lastname: Khan
authors.affiliation: Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600, Denmark.
authors.forename: Faisal Mohammad
authors.initials: FM
authors.lastname: Amin
authors.affiliation: Department of Neurosurgery, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Hauerberg
authors.affiliation: Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Markus
authors.initials: M
authors.lastname: Holtmannspötter
authors.affiliation: Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600, Denmark.
authors.forename: Julie Falkenberg
authors.initials: JF
authors.lastname: Petersen
authors.affiliation: Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600, Denmark.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Fakhril-Din
authors.affiliation: Department of Neurology, Odense University Hospital, Odense, Denmark.|Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
authors.forename: David
authors.initials: D
authors.lastname: Gaist
authors.affiliation: Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, 2600, Denmark.
authors.forename: Messoud
authors.initials: M
authors.lastname: Ashina
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006261:Headache / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology / Q000601:surgery*; D002538:Intracranial Arteriovenous Malformations / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000503:physiopathology*; D015995:Prevalence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Aneurysm; Arteriovenous malformation; Endovascular therapy; Headache; Post procedure; Risk