Magazine article Clinical Psychiatry News

Aneurysmal Coiling Often Leads to Acute Headache

Magazine article Clinical Psychiatry News

Aneurysmal Coiling Often Leads to Acute Headache

Article excerpt

CARLSBAD, CALIF. -- Nearly three quarters of patients had an acute headache after endovascular coiling of cerebral aneurysms in a review of a 3-year period at a single center.

The postprocedural headaches occurred significantly more often in women, smokers, and patients with a preprocedural history of headache or anxiety and depression, according to Dr. Eric P. Baron.

"Optimized risk-factor management prior to coiling may help decrease the occurrence of postcoiling headache.

"The presence of these risk factors may also help predict those more likely to complain of postcoiling headache and help guide clinical decisions of neuroimaging or other testing.

However, good clinical judgment should always supersede in these decisions," said Dr. Baron, a neurologist who is affiliated with the Center for Headache and Pain at the Cleveland Clinic Neurological Institute.

Although urgent diagnostic procedures to evaluate postcoiling headaches proved unhelpful, Dr. Baron and his colleagues found that triptans or dihydroergotamine (DHE) safely treated both pre- and postcoiling headaches in a small group of migraineurs.

Headache was also common in aneurysm patients before coiling, both for those who underwent emergent and elective coiling. Coiling resolved headaches in a small proportion of these patients, he noted.

"Triptans and DHE may not necessarily be a contraindication in all migraineurs with pre- and postcoiling headache, and aneurysmal coiling may actually resolve preexisting headaches in a select group of patients, but at this time, predicting that group of patients is unclear.

"Ultimately, further prospective studies are necessary to better evaluate all of these trends," Dr. Baron said.

The investigators reviewed the records of 263 adult patients (200 women and 63 men) who underwent either emergent or elective intracranial endovascular coiling for aneurysm treatment between July 2006 and June 2009.

Patients with skull defects, ventricular shunt placement, cranial trauma, extracranial procedures, and intracranial neoplasms or infections were excluded.

Most (76%) of the aneurysms were located in the anterior circulation; 24% were in the posterior circulation. A headache developed following coiling in 189 (72%) patients.

A significantly greater percentage of patients with headaches were women (81%). …

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