Abstract
Background and aim
Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke.
Methods
Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire.
Results
One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8–35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours.
Conclusions
Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity.
Highlights
- About one third of the patients who undergo a thrombectomy for acute stroke experience headache directly related to the procedure.
- Having a previous history of primary headache is associated with the presence of headache after thrombectomy.
- Headache related to thrombectomy usually coincides with the distribution of the affected artery, although it is bilateral in 45% of the cases, mostly oppressive, of an average duration between 1 and 2 days and of a moderate intensity.
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Introduction
Headache caused directly by an intracranial endarterial procedure is described in the current Classification of Headache Disorders (ICHD-3) as “unilateral, ipsilateral to the procedure and lasting less than 24 hours” [1]. Its diagnostic criteria require at least 3 of the following 4: 1) headache has developed within 1 week of the procedure; 2) headache has resolved within 1 month after the procedure; 3) headache is ipsilateral to the procedure or bilateral; and 4) headache has one of the following sets of characteristics: a) severe, occurring abruptly within seconds of the procedure and lasting < 1 hour, b) moderate to severe, develo** within hours of the procedure and lasting > 24 hours, and c) occurring in a patient with migraine and having the features of migraine with or without aura. These features define the three subtypes of headache attributed to an intracranial endarterial procedure recognized in the ICDH-3 classification. Mainly in terms of headache duration, current criteria are confusing, possibly as intracranial endarterial procedures today encompass a variety of procedures, for example, angioplasty, embolization, stent placement, etc., which depend on the indication to be treated [2,3,4,5,6,7,8].
Endovascular mechanical thrombectomy is the most efficacious treatment for ischemic stroke secondary to occlusion of brain arterial circulation [9,2.
Discussion
Endovascular mechanical thrombectomy has revolutionized the treatment of acute ischemic stroke [9,16,17,18,19]. In our study almost one-third of patients experienced de novo headache related to the procedure, although it must be taken into account that general anaesthesia was used in a high number of patients and we could have missed some headaches because of this. Even though the relatively low numbers of patients experiencing headaches explain the lack of statistical significance of many variables in this series, numerical data indicate that referring to a history of primary headache could be a risk factor for the development of headache related to thrombectomy. Procedural complexity did not increase the proportion of headache. The real value of these clinical variables as potentially predictors of incidence and severity of headache related to thrombectomy should be validated in future studies with a higher number of patients.
Conclusions
This prospective study shows that almost one out of three patients with ischemic stroke who undergo a thrombectomy will experience headache in the first 24 hours usually oppressive, moderate and lasting an average of 1–2 days. Headache characteristics meet well current ICHD-3 criteria for the subtype b of 6.7.1 Headache attributed to an intracranial procedure.
Availability of data and materials
Data from this study are available on request to the corresponding author.
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Authors were responsible for conception and design (J.P., D.G.), acquisition of clinical data (D.G., L.M., M.P., A.G., E.T., E.P., J.V., J.P.), analysis and interpretation of data (D.G., L.M., M.P., J.M., J.P.), drafting of the manuscript (J.P., D.G.), and supervision (J.P.). The author(s) read and approved the final manuscript.
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Gallo, D., Manrique, L., Polanco, M. et al. De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study. J Headache Pain 23, 85 (2022). https://doi.org/10.1186/s10194-022-01455-3
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DOI: https://doi.org/10.1186/s10194-022-01455-3