Department of Neurosurgery, Myongji Hospital, Goyang, Republic of Korea.
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
Cerebrovasc Dis. 2023;52(3):266-274. doi: 10.1159/000526551. Epub 2023 Mar 21.
Patients with moyamoya disease (MMD) often have headaches after successful revascularization surgery. We aimed to characterize headache in surgically treated MMD patients and elucidate its clinical meaning and pathophysiology.
Headache and related symptoms were surveyed using structured questionnaires in pediatric MMD patients with follow-up for 6 months or longer after indirect revascularization surgery. Clinical information including initial presentation, surgical method, and outcome was collected from medical records. Surgical outcomes were assessed clinically and by perfusion imaging. We defined "headache associated with MMD" as the headache accompanied by a transient ischemic attack or provoked by hyperventilation. Other headaches were further classified based on the diagnostic criteria of the International Headache Society-3. We analyzed the characteristics of "headache associated with MMD" and newly developed headache after surgery.
Among 90 participants, 65 (72.2%) had headaches within the last year before survey, including 28 (43.1%) with "headaches associated with MMD," 10 (15.3%) with probable migraines, 2 (3.1%) with infrequent episodic tension-type headaches, and 4 (6.2%) with probable tension-type headaches. Headache quality was pulsatile in 27 (41.5%) patients and pressing or tightening in 27 (41.5%) patients. Nausea or vomiting was accompanied in 30 (46.2%) patients. Headache upon awakening was reported in 37 (57.8%) patients. Headache disturbed daily life in 12 (18.5%) patients. Among the 32 (35.6%) patients who suffered headache during both the pre- and postoperative period, the headache quality was similar in 27 (84.4%) patients, and its severity decreased in 24 (75.0%) and did not change in 8 (25.0%) patients. Twelve (13.3%) patients experienced newly developed headaches after surgery. Among them, six (50.0%) were classified as having "headaches associated with MMD." They were predominantly electric shock-like or stabbing in 5 (45.6%) patients and nondisturbing in all patients. All 90 patients achieved improvement of ischemic symptoms after surgery.
Headaches often persist or newly develop after revascularization surgery in MMD patients. Accompanying nausea or vomiting and occurrence upon awakening are characteristic features. Postoperative headache does not necessarily imply insufficient disease control.
成功的血运重建手术后，烟雾病（MMD）患者常出现头痛。我们旨在描述接受手术治疗的 MMD 患者的头痛特征，并阐明其临床意义和病理生理学。
对接受间接血运重建手术后随访 6 个月或更长时间的儿科 MMD 患者，使用结构化问卷调查头痛和相关症状。从病历中收集包括初始表现、手术方法和结果在内的临床信息。通过灌注成像和临床评估来评估手术结果。我们将“与 MMD 相关的头痛”定义为伴有短暂性脑缺血发作或由过度通气引起的头痛。根据国际头痛协会第 3 版的诊断标准，进一步对其他头痛进行分类。我们分析了“与 MMD 相关的头痛”和手术后新发头痛的特征。
在 90 名参与者中，65 名（72.2%）在调查前一年有头痛，其中 28 名（43.1%）有“与 MMD 相关的头痛”，10 名（15.3%）可能为偏头痛，2 名（3.1%）为偶发性阵发性紧张型头痛，4 名（6.2%）为可能的紧张型头痛。27 名（41.5%）患者头痛性质为搏动性，27 名（41.5%）患者头痛性质为压迫性或紧束性。30 名（46.2%）患者伴有恶心或呕吐。37 名（57.8%）患者报告头痛在清晨发作。12 名（18.5%）患者头痛影响日常生活。在 32 名（35.6%）在术前和术后均有头痛的患者中，27 名（84.4%）患者头痛性质相似，24 名（75.0%）患者头痛严重程度减轻，8 名（25.0%）患者头痛无变化。术后 12 名（13.3%）患者新发头痛。其中，6 名（50.0%）被归类为“与 MMD 相关的头痛”。6 名（50.0%）患者为电击样或刺痛样头痛，所有患者头痛均不干扰日常生活。所有 90 名患者在手术后缺血症状均有改善。
血运重建手术后，MMD 患者的头痛常持续存在或新发。伴有恶心或呕吐和清晨发作是其特征性表现。术后头痛并不一定意味着疾病控制不足。
