Headache, Cerebral Aneurysms, and the Use of Triptans and Ergot Derivatives

Abstract

Associations between some headaches and aneurysms may exist. Some chronic headaches may respond to surgical aneurysm repair while others may worsen. These associations are undefined by current literature because of variable results, study methods, and limited data. Prospective studies are needed which incorporate pre- and post-procedure headache character and diagnosis, aneurysm characteristics, type of aneurysm repair, associated risk factors for worsening post-procedure headache, and ultimately combining all of these data to better predict headache outcome following surgical aneurysm treatment. Lastly, the caution and avoidance of triptan and ergot derivative use for migraine in the setting of aneurysm is not supported by the current evidence, and much of this concern may be excessive and unwarranted, although more evidence confirming safety is needed.

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

“…Several studies have reported headache improvement after such procedures, but many studies have reported incidences of worsening or new-onset headaches ranging between 10% and 55%. [3][4][5][6][7][8] In ICHD-3 beta, Chapter 6.7.1, headache attributed to an intracranial endovascular procedure appears to be based primarily on small-sample studies, most of which were conducted more than 20 years ago [9][10][11][12] (Table 1). Moreover, these studies were based on local anesthesia that was generally used in carotid or vertebral embolizations or angioplasties.…”

Triptans for Migraine Patients With Vascular Risks: New Insights, New Options

“…63 Case reports involving triptan-related cerebrovascular complications in this patient group do exist but provide no definite support for causality. 63 Case reports involving triptan-related cerebrovascular complications in this patient group do exist but provide no definite support for causality.…”

“…63 Case reports involving triptan-related cerebrovascular complications in this patient group do exist but provide no definite support for causality. 63 A study of 12,339 migraineurs using injectable sumatriptan reported no intracranial hemorrhages over a 1-year period,as about 5% of the general population has an asymptomatic aneurysm, this can be interpreted as at least somewhat reassuring, 65,66 In regard to AVMs, evidence is scarce. 64 In a retrospective series of 10 patients with untreated and 10 with coiled aneurysms who were using triptans, no complications occurred.…”

“…Beyond the risk of ischemic stroke, the clinician is often confronted with migraine patients known to have a congenital cerebrovascular anomaly such as an aneurysm or arteriovenous malformation (AVM). 63 Case reports involving triptan-related cerebrovascular complications in this patient group do exist but provide no definite support for causality. One such report described the complication-free use of triptans by a 28-year-old woman with multiple aneurysms over a 15-years period preceding surgery.…”

“…64 In a retrospective series of 10 patients with untreated and 10 with coiled aneurysms who were using triptans, no complications occurred. 63 A study of 12,339 migraineurs using injectable sumatriptan reported no intracranial hemorrhages over a 1-year period,as about 5% of the general population has an asymptomatic aneurysm, this can be interpreted as at least somewhat reassuring, 65,66 In regard to AVMs, evidence is scarce. Henkes et al administered subcutaneous or intra-arterial sumatriptan to 3 patients without AVMS, 2 patients with an arteriovenous fistula and 3 patients with an AVM.…”