Incidence and risk factors of postoperative headache after endovascular coil embolization of unruptured intracranial aneurysms

Abstract

Endovascular coil embolization for unruptured intracranial aneurysms (UIAs) has gained popularity because of its low morbidity and mortality in a short-term context. However, Headache is sometimes brought about or worsened after endovascular treatment, and this complaint may lead to perplexing situations, albeit infrequently. The aim of this study is to estimate the practical incidence and risk factors of postoperative headache in patients with endovascular embolization of UIAs. One hundred and thirty patients who underwent endovascular treatment of UIAs between March 2006 and May 2012 were enrolled according to inclusion criteria. From a retrospective chart review, the patients who had worsening or newly developed headache from postoperative day 1 to in-hospital stay were investigated for analyzing risk factors of post-embolization headache. Factors based on patients' demographics, anatomical and radiological features of the lesions, treatment, utilized devices and outcome were investigated, and statistically verified. Headache occurred or was exacerbated in 32 patients (24.6 %). Of these, 30 patients showed improvement within days, but two patients with previous migraine history complained of intermittent headache over 3 months after the embolization. Univariate comparison between the headache group and the non-headache group showed that internal carotid artery (ICA) segment aneurysm, stent-assisted coiling, and no history of hypertension were associated with post-embolization headache (p < 0.05). However, stent-assisted coiling and no history of hypertension were significantly associated with post-embolization headache in logistic regression analysis (p < 0.05). In the current study, stent-assisted coiling and no history of hypertension were important risk factors for headache in patients undergoing endovascular coil embolization for UIAs. Further investigations are still necessary to confirm the correlation of other factors which did not reach statistical significance in post-embolization headache in this limited study.