Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Center for Cerebrovascular Research, University of California, San Francisco, CA, USA.
J Headache Pain. 2024 May 7;25(1):72. doi: 10.1186/s10194-024-01774-7.
Due to the high mortality and disability rate of intracranial hemorrhage, headache is not the main focus of research on cerebral arteriovenous malformation (AVM), so research on headaches in AVM is still scarce, and the clinical understanding is shallow. This study aims to delineate the risk factors associated with headaches in AVM and to compare the effectiveness of various intervention treatments versus conservative treatment in alleviating headache symptoms.
This study conducted a retrospective analysis of AVMs who were treated in our institution from August 2011 to December 2021. Multivariable logistic regression analysis was employed to assess the risk factors for headaches in AVMs with unruptured, non-epileptic. Additionally, the effectiveness of different intervention treatments compared to conservative management in alleviating headaches was evaluated through propensity score matching (PSM).
A total of 946 patients were included in the analysis of risk factors for headaches. Multivariate logistic regression analysis identified that female (OR 1.532, 95% CI 1.173-2.001, p = 0.002), supply artery dilatation (OR 1.423, 95% CI 1.082-1.872, p = 0.012), and occipital lobe (OR 1.785, 95% CI 1.307-2.439, p < 0.001) as independent risk factors for the occurrence of headaches. There were 443 AVMs with headache symptoms. After propensity score matching, the microsurgery group (OR 7.27, 95% CI 2.82-18.7 p < 0.001), stereotactic radiosurgery group(OR 9.46, 95% CI 2.26-39.6, p = 0.002), and multimodality treatment group (OR 8.34 95% CI 2.87-24.3, p < 0.001) demonstrate significant headache relief compared to the conservative group. However, there was no significant difference between the embolization group (OR 2.24 95% CI 0.88-5.69, p = 0.091) and the conservative group.
This study identified potential risk factors for headaches in AVMs and found that microsurgery, stereotactic radiosurgery, and multimodal therapy had significant benefits in headache relief compared to conservative treatment. These findings provide important guidance for clinicians when developing treatment options that can help improve overall treatment outcomes and quality of life for patients.
由于颅内出血的高死亡率和致残率，头痛并不是脑动静脉畸形（AVM）研究的重点，因此对 AVM 头痛的研究仍然很少，临床认识也很肤浅。本研究旨在描述与 AVM 头痛相关的危险因素，并比较各种干预治疗与保守治疗在缓解头痛症状方面的效果。
本研究对 2011 年 8 月至 2021 年 12 月在我院治疗的 AVM 患者进行回顾性分析。采用多变量逻辑回归分析评估未破裂、非癫痫性 AVM 头痛的危险因素。此外，通过倾向评分匹配（PSM）评估不同干预治疗与保守治疗相比在缓解头痛方面的效果。
共纳入 946 例头痛危险因素分析患者。多变量逻辑回归分析发现，女性（OR 1.532，95%CI 1.173-2.001，p=0.002）、供血动脉扩张（OR 1.423，95%CI 1.082-1.872，p=0.012）和枕叶（OR 1.785，95%CI 1.307-2.439，p<0.001）是头痛发生的独立危险因素。443 例 AVM 出现头痛症状。经过倾向评分匹配后，手术组（OR 7.27，95%CI 2.82-18.7，p<0.001）、立体定向放射外科组（OR 9.46，95%CI 2.26-39.6，p=0.002）和多模态治疗组（OR 8.34，95%CI 2.87-24.3，p<0.001）与保守组相比，头痛缓解明显。然而，栓塞组（OR 2.24，95%CI 0.88-5.69，p=0.091）与保守组之间无显著差异。
本研究确定了 AVM 头痛的潜在危险因素，发现与保守治疗相比，手术、立体定向放射外科和多模态治疗在缓解头痛方面具有显著优势。这些发现为临床医生制定治疗方案提供了重要指导，有助于改善患者的整体治疗效果和生活质量。
