Background: No reliable estimates of headaches following catheter based cerebral angiography are available. We performed a prospective study to ascertain the frequency and type of headaches following cerebral angiography including time to resolution.
Methods: Consecutive patients who underwent diagnostic catheter based cerebral angiography through the transfemoral (or infrequently radial) route using iodixanol (270 mg/ml) injection were included. Each patient underwent a brief neurological assessment after the procedure by a board-certified neurologist and more detailed assessment was performed if any patient reported occurrence of any headache. The headaches were classified as migraine if the diagnostic criteria specified by International Headache Society were met. The severity of headache was classified using a visual analog scale rating from 0-10. Another endpoint was the time to reach pain free status for two consecutive hours.
Results: A total of 168 patients (mean age 60.5 ±SD 16.2 years; 90 were men) underwent diagnostic cerebral angiography. Of the 168 patients, 5 (3.0%, 95% confidence interval [CI]1.1%-6.6%) reported occurrence of migraine headaches and14 (8.3%, 95% CI 4.7%-13.7%) reported occurrence of non-migraine headaches. The median severity of migraine headaches was 10/10 and time (in minutes) to resolution of headaches was 140 minutes (range 60-360); two patient did not have complete resolution within 48 hrs of procedure. Of the patients with history of migraine, 3 (1.8%, 95% CI 0.5%-4.9%) reported occurrence of migraine headaches and 5 (3.0% 95% CI 1.0%-6.6%) reported occurrence of non-migraine headaches. Occurrence rates for migraine headaches in men and women were 1.1% (95% CI 0.1%-5.5%) and 3.9% (95% CI 1.0%-10.7%), respectively. Occurrence rates for migraine headaches was very high among patients with arterial dissections: 22.2 %, (95% CI 3.7% - 73.4%), although numbers were small.
Conclusions: We provide occurrence rates of migraine and non-migraine headaches, an under recognized adverse event, in patients undergoing catheter based cerebral angiography.