Characteristics of headache during and after digital substraction angiography: A critical re-appraisal of the ICHD-3 criteria

Abstract

Introduction Headache is a frequent but neglected side effect of angiography, and the criteria for angiography related headache have been based on only a few studies. Methods One-hundred and thirty nine patients who underwent cerebral angiography and 30 controls who underwent peripheral angiography participated in this prospective, non-randomized, case-control study. Participants were instructed to tell the angiography staff in case a headache developed and were questioned about their headache just after, 24 hours after, and one week after angiography. Results In the cerebral angiography group 42 patients (30.2%) had procedural headache compared to three of the controls (10%). Two different types of headache related to angiography were observed: one during angiography, which was related to contrast injection, and the other occuring within 24 hours. Both headaches were more frequent in patients with a history of primary headache, but were distinctly different from the premorbid headache. Headache characteristics are described in detail. Discussion Both types of headache related to angiography did not match the ICHD-3beta criteria for angiography headache, but were similar to headaches reported in studies that were not included in the current criteria. The timing and characteristics of these headaches are discussed in the light of our and previous reports. We suggest that the present ICHD-3 beta criteria are inadequate in properly defining angiography headache and should be revised in the light of the present literature.

Characteristics of Headache After an Intracranial Endovascular Procedure: A Prospective Observational Study

“…In total, we examined 10 qualified studies. 15 Moreover, in this study, most of the worsening or new-onset headaches lasted more than 24 hours. 5 In a retrospective study, Takigawa et al reported that 41 (46.6%) patients complained of onset of headaches just after the procedures, and the duration of headaches was 3.44 6 1.22 days.…”

“…However, they argued that the exact timeframe of headache onset was debatable and could be reduced further as the post-angiography headaches in their patients began a mean of 6 hours and median of 4 hours after angiography. 15 Moreover, in this study, most of the worsening or new-onset headaches lasted more than 24 hours. Previous related studies [3][4][5][6][7]12,[16][17][18][19] almost unanimously reported that most markedly worsening or newonset headaches resolved within several days, consistent with the current study.…”

Headache improvement after intracranial endovascular procedures in Chinese patients with unruptured intracranial aneurysm

“…Particularly, it will be more helpful to illuminate the headache changes if a well-designed study was conducted in which cerebral Digital Subtraction Angiography (DSA) group and peripheral angiography served as 2 control groups. [ 33 ]…”

Clinical characteristics of headaches attributed to diagnostic and therapeutic procedures

“…The frequency of post angiography headache ranges from 30.2% to 39.1% 16,22,23 . Possibly a headache is due to irritation of the trigeminovascular system by contrast agents or mechanical stimuli, resulting in the release of vasoactive peptides 24 .…”