• Anna M Schneider, Justin M Moore, Nimer Adeeb, Raghav Gupta, Christoph J Griessenauer, Peter A Winkler, Sarah Sieber, Abdulrahman Y Alturki, Christopher S Ogilvy, and Ajith J Thomas.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Paracelsus Medical University, Salzburg, Austria.
• World Neurosurg. 2018 May 1; 113: e364-e372.

IntroductionThe objective of this study was to analyze patients' perceptions of their headaches both before and after Pipeline flow diversion treatment of their unruptured intracranial aneurysms, with the goal of identifying prognostic factors associated with headache patterns to improve predictions of overall outcomes.MethodsWe retrospectively identified 133 patients treated with the Pipeline embolization device (PED) between January 1, 2014, and December 31, 2016, at an academic institution in the United States. Patients with at least 6 months of clinical follow-up, who had completed a validated telephone survey assessing their headache perceptions before and after treatment of their UIAs, were included.ResultsSixty patients (57.7%) responded to the questionnaire. Median aneurysm size was 6.3 mm. Thirty-two patients (53.3%) presented with headaches before treatment, which had a median intensity of 7 out of 10 (range, 3-10). On postprocedural evaluation, 8 patients (25%) had complete resolution of their headaches. Of the 24 (75%) patients with persistent headaches, the frequency and severity of the headaches decreased or remained the same in most (58.3%) patients. Eleven (18.3%) patients had new-onset headaches. This study found an association between aneurysm size and a reduction in headache frequency and severity after PED treatment. No significant association was found between headache persistence, severity, or frequency and patient demographics, aneurysm characteristics, and other comorbidities.ConclusionAn overall improvement of headaches in patients with UIAs who underwent treatment with the PED was observed, particularly in patients harboring large aneurysms and who had presented with daily headaches.Copyright © 2018 Elsevier Inc. All rights reserved.

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