title: Headache changes prior to aneurysmal rupture: A symptom of unruptured aneurysm?
abstract: OBJECTIVE
  The symptomatic status of unruptured aneurysms has to be looked for. The objective of this retrospective case-control study was to identify the headache semiologic characteristics of symptomatic aneurysms during the 3 months prior to patient admission.
  
  
  METHODS
  The case cohort was composed of 40 consecutive patients admitted for the treatment of a ruptured intracranial aneurysm (IA) and able to answer a standardized questionnaire by the same neurologist. This cohort was matched with a control cohort of 40 patients operated on for a degenerative lumbar pathology. This questionnaire, using the criteria for headache characteristics according to the International Headache Society (IHS) enabled us to classify headaches during the previous 3 months prior to the rupture (study period) and during the year prior to the period studied (reference period) in both cohorts. Headache status was considered as unstable if there were modifications of semiologic headache characteristics, thunderclap headaches or de novo headaches, or on the contrary stable.
  
  
  RESULTS
  During the status period, chronic headaches were reported by 31 patients (77.5%) in the studied cohort and 35 (87.5%) in the control cohort. During the study period, the cephalagia status was stable in 19 patients (47.5%) versus 35 patients (87.5%) in the control cohort (P<0.001). Modifications of chronic headaches were present in 11 patients (35.5%) in the studied cohort versus 4 patients (11.4%) in the control cohort (P=0.04). Thunderclap headaches were present in 7 patients (17.5%) in the studied cohort but none in the control cohort (P=0.006).
  
  
  CONCLUSIONS
  Modifications of headaches semiologic characteristics during the 3 previous months were significantly more frequent in the studied cohort. This modification could be a sign of IA instability.
authors.affiliation: Neurosurgery Department, Rouen University Hospital, 76000 Rouen, France.
authors.forename: V
authors.initials: V
authors.lastname: Gilard
authors.affiliation: Neurology Department, Rouen University Hospital, 76000 Rouen, France.
authors.forename: L
authors.initials: L
authors.lastname: Grangeon
authors.affiliation: Neurology Department, Rouen University Hospital, 76000 Rouen, France.
authors.forename: E
authors.initials: E
authors.lastname: Guegan-Massardier
authors.affiliation: Neurology Department, Rouen University Hospital, 76000 Rouen, France.
authors.forename: M
authors.initials: M
authors.lastname: Sallansonnet-Froment
authors.affiliation: Neurology Department, Rouen University Hospital, 76000 Rouen, France.
authors.forename: D
authors.initials: D
authors.lastname: Maltête
authors.affiliation: Neurosurgery Department, Rouen University Hospital, 76000 Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Derrey
authors.affiliation: Neurosurgery Department, Strasbourg University Hospital, Hautepierre Hospital, 1, avenue Molière, 67098 Strasbourg, France. Electronic address: f.proust@neurochirurgie.fr.
authors.forename: F
authors.initials: F
authors.lastname: Proust
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016022:Case-Control Studies; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Cerebral aneurysm; Chronic headache; Sentinel headache; Thunderclap headache