The course of moderate-to-severe headaches in patients undergoing endovascular treatment for unruptured intracranial aneurysms: A retrospective cross-sectional study

Abstract

Background: This retrospective cross-sectional study aimed to investigate the course of newly onset moderate-to-severe headaches in patients who underwent endovascular treatment (EVT) for unruptured intracranial aneurysms (UIAs). Methods: Between September 2009 and May 2022, 412 patients were included, and all met the following criteria: (1) presence of UIAs on computed tomography angiography or magnetic resonance angiography; (2) newly onset moderate-to-severe headache (Numeric Rating Scale, NRS >= 4) around the time of UIAs diagnosis; and (3) EVT of UIAs. We evaluated initial and follow-up NRS scores to determine the significance of NRS changes and identified predisposing factors for headache improvement at the 12-month follow-up. Results: Compared to the NRS score (7.14) before EVT, the average NRS score (4.02) significantly decreased at discharge (p < 0.05). Subsequently, the follow-up NRS scores at 1-month (2.14), 6-month (1.65), and 12-month (1.27) were significantly decreased (p < 0.01). Follow-up NRS scores decreased continuously until the 12-month follow-up. A history of stroke (odds ratio [OR] = 0.539, 95% confidence interval [CI] 0.196 to 0.806; p = 0.039) and procedure-related complications (OR = 0.567, 95% CI 0.218 to 0.728; p = 0.045) were identified as independent predisposing factors of headache improvement on multivariate logistic regression analysis. Conclusion: After EVT of UIAs, patients with newly onset moderate-to-severe headaches experienced significant headache improvement at discharge, with NRS continuously decreasing over the 12 months of follow-up. Headache improvement might be expected in patients who do not have a history of stroke and in those who have not experienced procedure-related complications.