This is a case report of a 39-year-old man who suffered from a fatal cerebellar infarction whilst on sumatriptan therapy for an acute attack of migraine. Intracranial vasospasm is proposed as the likely causative mechanism and possible therapeutic intervention is highlighted.

Fatal cerebellar infarction in a migraine sufferer whilst receiving sumatriptan.

(Headache 2012;52:739-748)



Aims.— Predicting who will develop post-procedure headache (PPH) following intracranial endovascular procedures (IEPs) would be clinically useful and potentially could assist in reducing the excessive diagnostic testing so often obtained in these patients. Although limited safety data exist, the use of triptans or dihydroergotamine (DHE) often raise concern when used with pre/post-coiled aneurysms. We sought to determine risk factors for PPH following IEP, to evaluate the utility of diagnostic testing in patients with post-coil acute headache (HA), and to record whether triptans and DHE have been used safely in this clinical setting.



Methods.— We conducted a retrospective chart review of adult patients undergoing IEPs. Bivariate analyses were conducted to compare patients who did and did not develop PPH.



Results.— We reviewed records pertaining to 372 patients, of whom 263 underwent intracranial coil embolizations, 21 acrylic glue embolizations, and 88 stent placements. PPH occurred in 72% of coil patients, 33% of glue patients, and 14% of stent patients. Significant risk factors for post-coil HA were female gender, any pre-coil HA history, smoking, and anxiety/depression. A pre-stent history of HA exceeding 1 year's duration, and smoking were risk factors for post-stent HA. A pre-glue history of HA exceeding 1 year was the only risk factor for post-glue HA. In the small subgroup available for study, treatment with triptans or DHE was not associated with adverse events in pre/post-coiled aneurysms. Diagnostic testing was low yield.



Conclusions.— Occurrence of PPH was common after IEPs and especially so with coiling and in women, smokers, and those with anxiety/depression, and was often of longer duration than allowed by current International Classification of Headache Disorders-II criteria. The yield of diagnostic testing was low, and in a small subgroup treatment with triptans or DHE did not cause adverse events in pre/post-coiled aneurysms. Prospective studies are needed to confirm these findings.

Headache Following Intracranial Neuroendovascular Procedures

Objective.—To describe three cases of migraine (two with aura) after an intracranial endovascular procedure.



Method.—Retrospective.



Results.—One patient had an attack of migraine with prolonged aura after embolization of a dural arteriovenous fistula. Another patient had an attack of migraine with aura (and hemiparesis) after a diagnostic angiogram. The third patient already suffered from migraine with aura and had a migraine attack after embolization of an occipital arteriovenous malformation. A quadrantanopia persisted in this patient. Outcome of the other two patients was good.



Conclusion.—Intracranial endovascular procedures can induce migraine with aura. We could not identify the underlying pathophysiological mechanism, but mechanical, chemical, immunological, or hemodynamic factors could be involved.

https://headachejournal.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1526-4610.2001.111006410.x

Migraine with aura after intracranial endovascular procedures.

Headache is a common symptom after cerebral angiography, although it has seldom been studied. We aimed to evaluate the frequency of headache at 24 h and 6 months after angiography and to describe its characteristics. We used a cross-sectional survey of consecutive patients submitted to angiography and determined headache presence and its characterization. Headache occurrence was analyzed against headache history, clinical data, technical and demographical variables. Of 107 procedures studied, 51.3% patients experienced headaches within 24 h. Patients more likely to experience headaches were females or had subarachnoid hemorrhage. Six months post-procedure 48.8% of patients had frequent headaches. These patients had a positive headache history before the procedure, migraine in particular. Half of patients undergoing routine angiography experience benign post-procedure headaches within 24 h (especially women), yet it does not seem to predispose to chronic long-term headaches.

/pdf/post-angiography-headaches-3gj69qisa7.pdf

Post-angiography headaches

Pendahuluan: Digital subtraction angiography (DSA) serebral menjadi gold standard untuk memeriksa penderita dengan gangguan serebrovaskular Banyak kemajuan yang telah diperoleh untuk meningkatkan keamanan penggunaan DSA serebral, seperti kontras yang lebih aman, kateter yang lebih kecil, kawat ( hydrophilic guides ), dan sistem pengamatan digital yang semakin baik Hingga saat ini, belum ada penelitian terkait komplikasi neurologis maupun non-neurologis dari prosedur DSA yang dilakukan di Indonesia Tujuan penelitian ini adalah mengetahui berbagai komplikasi prosedur DSA, sehingga operator dapat meminimalisasi timbulnya komplikasi tersebut saat prosedur DSA dilakukan di kemudian hari Metode penelitian: Penelitian deskriptif dilakukan di RSUD Dr Moewardi terhadap 486 pasien yang menjalani prosedur DSA Data yang dikumpulkan meliputi umur, jenis kelamin, komplikasi, serta temuan angiografi Komplikasi neurologis dan non neurologis dikelompokkan menjadi: early , yang akan menghilang kurang dari 7 hari dan late , bila komplikasi terjadi lebih dari 7 hari Kriteria inklusi pada penelitian ini adalah semua pasien yang menjalani prosedur DSA di RSUD Dr Moewardi periode Juni 2013 hingga Mei 2018 dan pasien yang mengalami komplikasi neurologis dan non-neurologis Hasil penelitian: Terdapat 15 (3%) dari 486 pasien yang menjalani prosedur DSA serebral mengalami komplikasi Komplikasi neurologis early terjadi pada 10 kasus (2%), dan tidak didapatkan komplikasi pada tipe late , sedangkan komplikasi non-neurologis early terjadi pada 2 kasus (04%), dan late pada 3 kasus (06%) Kejadian ini sebanding dengan penelitian yang dilakukan oleh studi internasional lainnya Kes impulan: Prosedur DSA serebral relatif aman, baik dalam hal komplikasi neurologis, komplikasi non-neurologis maupun terjadinya kematian Komplikasi neurologis yang terjadi masih dalam batas yang direkomendasikan sesuai dengan petunjuk keamanan untuk melakukan DSA serebral Kata kunci: Angiografi serebral; keamanan; komplikasi

/pdf/komplikasi-neurologis-dan-non-neurologis-prosedur-digital-35rdw75qz8.pdf

Komplikasi Neurologis dan Non-Neurologis Prosedur Digital Subtraction Angiography Serebral di RSUD Dr. Moewardi Periode Juni 2013-Mei 2018

Four patients were investigated for cerebrovascular origin of focal neurologic deficits. Three of the patients had persistent deficits. However, during cerebral angiography and subsequent regional cerebral blood flow (rCBF) investigation all patients developed attacks of migraine with aura. During the rCBF study focal reduction of the blood flow, typical for migraine with aura, developed in the posterior brain regions. It is concluded that vasospasm of migrainous origin might be the cause of the neurological deficits in the four patients.

Migraine with aura (classical migraine) in patients examined for cerebrovascular disease

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Migraine with aura (classical migraine) in patients examined for cerebrovascular disease