The course of moderate-to-severe headaches in patients undergoing endovascular treatment for unruptured intracranial aneurysms: A retrospective cross-sectional study

Abstract Background This retrospective cross-sectional study aimed to investigate the course of newly onset moderate-to-severe headaches in patients who underwent endovascular treatment (EVT) for unruptured intracranial aneurysms (UIAs). Methods Between September 2009 and May 2022, 412 patients were included, and all met the following criteria: (1) presence of UIAs on computed tomography angiography or magnetic resonance angiography; (2) newly onset moderate-to-severe headache (Numeric Rating Scale, NRS ≥ 4) around the time of UIAs diagnosis; and (3) EVT of UIAs. We evaluated initial and follow-up NRS scores to determine the significance of NRS changes and identified predisposing factors for headache improvement at the 12-month follow-up. Results Compared to the NRS score before EVT, the average NRS scores significantly decreased at discharge (P < 0.05). Subsequently, the follow-up NRS scores at 1-month, 6-month, and 12-month were significantly decreased (P < 0.01). Follow-up NRS scores decreased continuously until the 12-month follow-up. In multiple logistic regression analysis, a history of stroke (odds ratio [OR] = 0.539, 95% confidence interval [CI] 0.196 to 0.806; P = 0.039) and procedure-related complications (OR = 0.567, 95% CI 0.218 to 0.728; P = 0.045) were identified as independent predisposing factors of headache improvement. Conclusions After EVT of UIAs, patients with newly onset moderate-to-severe headaches experienced significant headache improvement at discharge, with NRS scores continuously decreasing over the 12 months of follow-up. Headache improvement might be expected in patients who do not have a history of stroke and in those who have not experienced procedure-related complications.