Flow Diversion Endovascular Treatment Improves Headaches in Patients with Unruptured Intracranial Aneurysms.

Abstract Objective Headaches are the presenting symptom of unruptured intracranial aneurysms (UIA) in over one-third of cases. Several patients may expect their headaches to remit after aneurysm treatment. This study aims to identify factors influencing headache outcomes following endovascular treatment of UIAs. Methods A prospective, observational study was conducted on patients with UIAs treated with flow diversion. Subjects reported their headache intensity with the Visual Analogue Scale (VAS) and were given three surveys prior to treatment: Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), and Patient Health Questionnaire-2 (PHQ-2). Follow-up was at one, three and six months after treatment. Analysis was performed using generalized mixed effects models (GLMM). Results We identified 38 patients, 29 of whom reported headaches at baseline (76.3%). Mean (SD) age was 55.3±12.4 years, and 79% of patients were female. Mean (SD) aneurysmal diameter was 6.8±5.3 mm, and treatment modality was Pipeline embolization in all cases. At last follow-up, 5 (15.1%) aneurysms were incompletely occluded. Mean (SD) VAS scores for patients with headaches at baseline were 4.36±0.59 at baseline, 4.08±0.60 at one-month, 3.04±0.62 at three-month, and 2.76±0.57 at six-month follow-up. Controlling for occlusion status, medication, and depression, there was significant improvement at three- and six month-follow-up. Similar patterns were observed with MIDAS and HIT-6. Conclusions In the present study, endovascular UIA treatment lead to significantly decreased headache intensity for patients with headaches at baseline, after a short time delay. Our data can shed light on post-intervention headache patterns and help inform patient discussions and treatment expectations.