Headache following endovascular procedures
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HEADACHES AND CEREBROVASCULAR DISEASE
Headache following endovascular procedures Matteo Paolucci 1 & Marco Longoni 1 & Elio Clemente Agostoni 2
# Fondazione Società Italiana di Neurologia 2020
Cerebral endovascular procedures (EVPs) are fundamental diagnostic and therapeutic tools, routinely performed in an increasing number of centres. Continuous technological advances make EVPs a rapidly evolving field. Although EVPs drastically changed the prognosis of some neurovascular disorders, they carry some risks of major and minor complications. During or after an EVP, patients may complain of headache, a complex symptom that can range from mild discomfort to severe pain and, irrespective of its severity, may be benign or a warning sign of serious complications. On the other hand, several neurovascular conditions include headache as one of their presenting symptoms (e.g. unruptured aneurysms); in such cases, the headache usually improves after the procedure [1]. Headache attributed to EVPs refers to a new or a worsened headache following the procedure. The third edition of the International Classification of Headache Disorders (ICHD-3) published in 2018 recognizes different subtypes of headache attributed to EVPs. All of them are included in Chapter 6 of the classification (“Headache attributed to cranial and/or cervical vascular disorder”). They can be categorized into three main groups: headache due to extracranial arterial procedures (6.5.2 Post-endarterectomy headache, 6.5.3 Headache attributed to carotid or vertebral angioplasty or stenting), to venous procedures (6.6.2 Headache attributed to cranial venous sinus stenting) or to intracranial procedures (6.7.1 Headache attributed to an intracranial endovascular procedure, 6.7.2 Angiography headache). Post-endarterectomy headache is here discussed since it shares several clinical features and pathogenetic mechanisms with post-endovascular procedure headache. ICHD-3
* Marco Longoni [email protected] 1
Department of Neurology and Stroke Unit Cesena-Forlì, Bufalini Hospital, AUSL Romagna, viale Ghirotti 286, 47521 Cesena, Italy
2
Neurology and Stroke Unit, Department of Neuroscience, ASST GOM Niguarda, Milan, Italy
does not contemplate the post-thrombectomy headache, since the intracranial endovascular procedures subchapter has been built on data from aneurysms and arteriovenous malformations. However, post-thrombectomy headache cases have been reported [2]. The fundamental feature of post-procedural headache is the temporal relationship between the onset of a new headache or the worsening of a previous headache and the timing of the procedure. Usually, a headache may develop within one week of the procedure. However, there are some very early–onset subforms. During an intracranial procedure, for example, a severe headache may develop abruptly within a few seconds after balloon inflation or embolization of an arteriovenous malformation or aneurysm. Otherwise, during an angiography, pain may develop immediately during contrast injection, lasting less th
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