Cephalgia Following Flow Diversion of Unruptured Intracranial Aneurysms
Bibliographic record
Abstract
BACKGROUND: Headaches following treatment of unruptured intracranial aneurysms with flow diverting stents is a known, however under-reported, entity. Prevalence of this phenomenon, its clinical and procedural correlates, as well as its clinical course and correlation to aneurysm location and size have not been reported in the past. This manuscript aims to quantify the prevalence of the phenomenon, describe its natural course, and identify risk factors for its emergence. METHODS: Within our prospectively collected institutional database, we identified 141 consecutive patients treated electively for unruptured intracranial aneurysms by flow diversion between 2015 and 2021 who had a minimum of 2 years of clinical follow-up. The mean patient age was 55.7 (±13) y/o and 120/141 patients (85%) were females. Based on chart review and clinical notes we evaluated the presence of postprocedural headache complaints and correlated these with anatomical and periprocedural data. Additionally we have assessed charts of 88 patient who underwent aneurysm coiling without flow diversion during the same time period. RESULTS: Twenty-four (17%) patients complained of new headaches postflow diversion which were hemicranial or holocranial (n = 17) or retro-orbital (n = 7) in nature. Headaches were most common in paraclinoid, paraophthalmic, and cavernous aneurysms, while retro-orbital pain was correlated to larger aneurysms of same locations mean dimensions and older age (Pearson's correlation, 13 mm ± 5.4, P = 0.04; 65 ± 14, P = 0.048). Two stent constructs were also correlated to retro-orbital headaches (hazard ratio [HR] 3.8, P = 0.03, confidence interval [CI] 1.0-16.4). In addition, in 15 of 24 cases (62.5%) of headache presentations, the stent construct was crossing the dura. In 6 of 7 (87.5%) of patients presenting with retro-orbital headaches the stent construct was crossing the dural ring. The clinical course of the pain syndrome was invariably benign and short-lived (<1 year long). During the same time period only 3 patients (3.4%) in the elective coiling without flow diverter group presented with various duration of holocranial eventually resolving headaches. CONCLUSIONS: In our cohort, new postprocedural headaches following flow-diversion were present in 17% of patients thus constituting a common adverse event that was exclusively related to anterior circulation aneurysms, in contrast to only 3.4% prevalence of new postprocedural headaches following elective aneurysm coiling. The phenomenon was short-lived and benign, related to larger aneurysm size, proximity to the dural ring in the treated segment, double stent construct, and older age. We hypothesize that these headaches may be related to meningeal irritation. We recommend that patients are educated during the consent process of this phenomenon and its clinical course prior to treatment.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".