• Georgios A Maragkos, Sarah Cordell, Santiago Gomez-Paz, Laura E Dodge, Mohamed M Salem, Luis C Ascanio, Diane DiNobile, Abdulrahman Y Alturki, Justin M Moore, Christopher S Ogilvy, and Ajith J Thomas.
• Neurosurgery Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2020 Aug 1; 140: e140-e147.

ObjectiveHeadache is the presenting symptom of unruptured intracranial aneurysm (UIA) in more than one-third of cases. Some patients may expect their headache to remit after aneurysm treatment. This study aims to identify factors influencing headache outcomes following endovascular treatment of UIA.MethodsThis prospective observational study was conducted in patients with UIAs treated with flow diversion. Subjects reported their headache intensity with a visual analog scale (VAS) and completed 3 surveys before treatment: Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6), and Patient Health Questionnaire-2 (PHQ-2). Follow-up was at 1 month, 3 months, and 6 months after treatment. Analysis was performed using generalized mixed-effects models.ResultsWe identified 38 patients, 29 of whom reported headaches at baseline (76.3%). Mean patient age was 55.3 ± 12.4 years, and 79% of the cohort was female. Mean aneurysm diameter was 6.8 ± 5.3 mm, and treatment modality was Pipeline embolization in all cases. At the last follow-up, 5 aneurysms (15.1%) were incompletely occluded. The mean VAS scores for patients with headache at baseline were 4.36 ± 0.59 at baseline, 4.08 ± 0.60 at 1 month, 3.04 ± 0.62 at 3 months, and 2.76 ± 0.57 at 6 months. Controlling for occlusion status, medication, and depression, significant improvement was seen at the 3- and 6-month follow-ups. Similar patterns were observed with MIDAS and HIT-6.ConclusionsIn the present study, endovascular UIA treatment led to significantly decreased headache intensity in patients with headache at baseline, after a short delay. Our data shed light on postintervention headache patterns and can help inform patient discussions and treatment expectations.Copyright © 2020 Elsevier Inc. All rights reserved.

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