Gweh Demitre, Khan Sheena, Pelletier Lisa, Tariq Nauman, Llinas Rafael H, Caplan Justin, Marsh Elisabeth B
Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Neuroradiology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
J Vasc Interv Neurol. 2020 Jan;11(1):34-39.
Flow diversion using devices such as the "pipeline" stent is now a common treatment for unruptured intracranial aneurysms. Though much is known about the efficacy of the device, less is reported regarding potential side effects. In this study, we report the frequency and characteristics of the "post-pipeline headache."
We prospectively enrolled a cohort of 222 patients who underwent pipeline stenting for the treatment of intracranial aneurysm between 2015 and 2018. A follow-up telephone survey was conducted with a mean 21.6 months postprocedure evaluating postprocedure headaches and previous headache history. A post-pipeline headache was defined as a new headache or pain distinct from their prior headache syndrome. Information was collected regarding patient demographics, headache characteristics, headache history, and whether symptoms were ongoing. Logistic regression was used to determine factors associated with post-pipeline headache and the risk of long-term headache persistence.
Eighty-eight individuals were reached by phone for follow-up; 48 (55%) of whom reported a new headache postprocedure. Patients experiencing post-pipeline headache were more likely to be young (OR 0.9; 95% CI: 0.85-0.94) and have a history of prior headaches (OR 2.4, 95% CI: 1.02-5.81). Associated motor (OR 6.1; 95% CI: 1.19-31.47), cognitive (OR 7.0; 95% CI: 081-60.33), visual (OR 5.4; 95% CI: 1.05-27.89), and vestibular (OR 4.8; 95% CI: 1.14-20.23) symptoms were associated with ongoing headache.
Post-pipeline headache is common, particularly in younger individuals with prior headache history, and has distinctive features. Symptoms can remit over time; however, two-thirds experience ongoing headaches, particularly those with associated migrainous features.
使用“管道”支架等装置进行血流导向如今是未破裂颅内动脉瘤的常见治疗方法。尽管对该装置的疗效已了解很多，但关于潜在副作用的报道较少。在本研究中，我们报告了“管道置入术后头痛”的发生率及特征。
我们前瞻性纳入了2015年至2018年间接受管道支架置入术治疗颅内动脉瘤的222例患者队列。术后平均21.6个月进行了一次随访电话调查，评估术后头痛情况及既往头痛病史。管道置入术后头痛定义为与既往头痛综合征不同的新发头痛或疼痛。收集了患者人口统计学信息、头痛特征、头痛病史以及症状是否持续存在。采用逻辑回归确定与管道置入术后头痛相关的因素以及长期头痛持续的风险。
通过电话联系到88人进行随访；其中48人（55%）报告术后出现新发头痛。发生管道置入术后头痛的患者更可能年轻（比值比0.9；95%置信区间：0.85 - 0.94）且有既往头痛病史（比值比2.4，95%置信区间：1.02 - 5.81）。相关的运动（比值比6.1；95%置信区间：1.19 - 31.47）、认知（比值比7.0；95%置信区间：0.81 - 60.33）、视觉（比值比5.4；95%置信区间：1.05 - 27.89）和前庭（比值比4.8；95%置信区间：1.14 - 20.23）症状与持续性头痛相关。
管道置入术后头痛很常见，尤其是在有既往头痛病史的年轻个体中，且具有独特特征。症状可随时间缓解；然而，三分之二的患者会持续头痛，尤其是那些伴有偏头痛特征的患者。
