Headaches After Craniotomy Versus Endovascular Therapy for Aneurysms
Headaches can significantly impact quality of life after aneurysm treatment. Magalhães JE et al. (Headache, June 2013) performed a 4-month prospective cohort study comparing headaches in aneurysm patients after surgical clipping or endovascular coiling using the International Classification of Headache Disorders (ICHD-2) criteria. Post-craniotomy/procedure headaches (PCH) are defined as starting within 7 days and affecting the treated side. Standardized scales were used for assessing headaches, anxiety and depression. 101 patients were enrolled, with 45 surgical and 39 endovascular patients completing follow-up. The surgical group had significantly younger patients (46.7+/-11.1 years vs. 51.7+/- 13.7 years) and fewer women (60.4% vs. 79.2%). PCH occurred in 54.9% of surgical patients and 25.5% of endovascular patients. The relative risk of headaches after surgery vs. endovascular treatment was 2.15 (CI 1.24-3.72). No difference in persistent PCH (lasting longer than 3 months postop) was observed: 24% of surgery and 18% of endovascular patients had persistent headaches. Craniotomy is the major PCH risk factor. Persistent headaches are only associated with preop anxiety. This Class II evidence suggests significantly increased PCH risk in aneurysm patients undergoing surgical vs. endovascular therapy, with no difference 3 months post-treatment. Limitations of this study include short follow-up interval, inclusion of ruptured with unruptured aneurysms, and lack of details about the craniotomies. However, this study suggests that pre-procedural counseling should include discussion of postop headaches as a possible risk for both treatment modalities, especially craniotomy.