Headache Following Carotid Endarterectomy: A Prospective Study

Tehindrazanarivelo, Alain Djacoba; Lutz, Gina; Petitjean, Christian; Bousser, Marie‐Germaine

doi:10.1111/j.1468-2982.1992.00380.x

Cited by 21 publications

(12 citation statements)

References 8 publications

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“…However, these headaches are classified as mild to moderate in most patients (78%). 24 Sudden onset of severe unilateral headache ipsilateral to the endarterectomy site was documented in only 5 patients in this study. In addition, most studies have not confirmed the diagnosis of CHS with cerebral hemodynamic data.…”

Section: Discussionmentioning

confidence: 59%

Cerebral hyperperfusion syndrome after carotid endarterectomy: Predictive factors and hemodynamic changes

Ascher

Markevich

Schutzer

et al. 2003

Journal of Vascular Surgery

101

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Section: Discussionmentioning

confidence: 59%

Cerebral hyperperfusion syndrome after carotid endarterectomy: Predictive factors and hemodynamic changes

Ascher

Markevich

Schutzer

et al. 2003

Journal of Vascular Surgery

101

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“…Cluster-like headache was described to occur frequently in 2 studies [6,7], but in more recent studies, it was not observed at all [4,5]. Therefore, the incidence of this headache seems lower than described in the ICHD-IIIB criteria [9], unless we assume considerable underreporting.…”

Section: Discussionmentioning

confidence: 65%

“…Albuquerque et al [4] and Tehindrazanarivelo et al [5] studied the occurrence of headache following CEA. They do not describe any patients who developed cluster headache or a cluster-like headache following CEA.…”

Section: Literature Reviewmentioning

confidence: 99%

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Post-Operative Cluster Headache Following Carotid Endarterectomy

Dirkx

Koehler²

2017

Eur Neurol

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Background: Secondary cluster headache following carotid endarterectomy (CEA) is a rare condition and may help us understand the pathophysiology of primary cluster headache. Summary: We describe 2 patients diagnosed with cluster headache, fulfilling the ICHD-IIIB criteria, following CEA. Neither of the patients had headache prior to surgery. They both responded to treatment with oxygen and verapamil. Recent medical literature does not describe any definite cases of cluster headache following CEA. Cluster-like headache has been reported in several studies in the 1990s. Recent studies in primary cluster headache patients show evidence for a central origin of cluster headache in which no peripheral drive seems necessary. Key Messages: Our findings may provide more insight into the pathophysiology and show how a peripheral cause may lead to cluster headache. We hypothesize a role of the trigemino-autonomic reflex. Damage to the carotid artery may activate this reflex and trigger cluster headache. Injury to the internal carotid artery may unleash attacks in patients who are predisposed to develop cluster headache. Further study on the subject is needed to resolve this issue.

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“…In other studies, headache was usually described as a severe, pulsatile, temporal, frontal or retro-orbital pain, mainly ipsilateral to the treated artery [5,54]. The frequency of any post-CEA headache may reach 62% [55]. We considered all severe headaches to be symptoms of HS, irrespective of the headache laterality.…”

Section: Discussionmentioning

confidence: 99%

Hyperperfusion Syndrome after Carotid Endarterectomy and Carotid Stenting

Buczek

Karliñski²,

Kobayashi³

et al. 2013

Cerebrovasc Dis

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Background: Hyperperfusion syndrome (HS) is a relatively rare but possibly serious complication of carotid revascularization procedures. Impaired cerebral autoregulation and postrevascularization changes in cerebral blood flow are the main mechanisms involved in the development of HS. Most up-to-date studies addressing this issue are retrospective and tend to concentrate on carotid endarterectomy (CEA), neglecting carotid stenting (CAS). Our aim was to compare the frequency of clinical signs of HS and hyperperfusion detected by transcranial Doppler (TCD) in patients undergoing CAS or CEA due to carotid stenosis. Methods: In this prospective observational study, we evaluated 61 patients scheduled for routine CAS or CEA. Each patient was examined by a neurologist before and after the revascularization procedure to assess the clinical status. Severe headache, ocular or facial pain, confusion, visual disturbances, epileptic seizures or any focal deficits not caused by cerebral ischemia were considered clinical signs of HS. Peak systolic velocity (PSV), end-diastolic velocity, mean velocity (MV), and pulsatility index were measured by TCD once before and twice after the intervention (within 6 h after and 2-5 days after the procedure). Hyperperfusion was defined as a >100% increase in the middle cerebral artery (MCA) blood velocity, evaluated separately for PSV and MV after the procedure compared with the baseline value. Cerebrovascular reactivity (CVR) was evaluated with a TCD acetazolamide test before the intervention. Results: CAS (n = 33) and CEA (n = 28) patients were included in the study. There was no difference between the groups in the frequency of clinical signs of HS (21.2 vs. 21.4%) and ratio of TCD hyperperfusion (12.1 vs. 14.3%). In the CAS group, ipsilateral MCA velocity significantly increased directly after the intervention and 2-5 days later, while it increased in the CEA group only 2-5 days after the intervention. The sensitivity and specificity of hyperperfusion, defined by MV, for HS signs were 38.5 and 93.8%, respectively, whereas those defined by PSV were 30.8 and 89.6%, respectively. The sensitivity and specificity of impaired CVR (<25%) for HS signs were 63.6 and 73.5%, respectively. Conclusions: There is no difference in the frequency of HS clinical signs and hyperperfusion detected by TCD between patients after CAE and CAS. Clinical signs suggested HS does not always correspond with TCD hyperperfusion. However, both the CVR test and TCD measurements of MCA velocity can help identify patients at high risk for HS.

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Headache Following Carotid Endarterectomy: A Prospective Study

Cited by 21 publications

References 8 publications

Cerebral hyperperfusion syndrome after carotid endarterectomy: Predictive factors and hemodynamic changes

Cerebral hyperperfusion syndrome after carotid endarterectomy: Predictive factors and hemodynamic changes

Post-Operative Cluster Headache Following Carotid Endarterectomy

Hyperperfusion Syndrome after Carotid Endarterectomy and Carotid Stenting

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