Abstract
BackgroundRupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.MethodsIn a prospective case–control study 199 consecutive patients with SIA (103 females and 96 males, mean age: 43.2 years) received a semistructured face to face interview focusing on past headaches. All were admitted to hospital mostly because of rupture (177) or for unruptured aneurysm (22). In parallel we interviewed 194 blood donors (86 females, 108 males, mean age: 38.4 years). Diagnoses were made according to the International Headache Society criteria. Aneurysms were diagnosed by conventional cerebral angiography.ResultsDuring the year before rupture, 124 (62.3%) had one or more types of headache. These headaches included: migraine without aura (MO): 78 (39.2%), migraine with aura (MA): 2 (1%), probable migraine (PM): 4 (2%), tension-type headache (TTH): 39 (19.6%), cluster headache (CH): 2 (1%), posttraumatic headaches (PH): 2 (1%). 1-year prevalence of headaches in controls was 32.5% (63 patients out of 194), they included: TTH: 45 (23.1%), MO: 17(8.8%), PH: 1(0.5%). Only the prevalence of MO was significantly higher in patients with SIA (OR 6.7, 95% CI 3.8-11.9, p < 0.0001).ConclusionsUnruptured SIA cause a marked increase in the prevalence of migraine without aura but not in the prevalence of other types of headache.
Highlights
Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA
While the thunderclap headache associated with rupture of saccular intracranial aneurysm (SIA) is well known (ICHD-2) [1,2,3,4,5], it is much less certain if an unruptured SIA can cause headache
In the chapter devoted to aneurysms in a standard reference book on headache [11], it is stated that unruptured SIA may be a cause of headache but the underlying literature references are case stories or
Summary
Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA. While the thunderclap headache associated with rupture of saccular intracranial aneurysm (SIA) is well known (ICHD-2) [1,2,3,4,5], it is much less certain if an unruptured SIA can cause headache. Giant aneurysms causing compression or distortion of intracranial structures are an accepted cause of headache [9,10]. SIA that does not cause compression of a cranial nerve or other structures is not an intuitively obvious cause of headache. In the chapter devoted to aneurysms in a standard reference book on headache [11], it is stated that unruptured SIA may be a cause of headache but the underlying literature references are case stories or
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