Abstract Details

Title Headache Outcomes After Treatment of Cerebral Arteriovenous Malformations: A Systematic Review and Meta-analysis with Clinical Implications

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-019

Objective To evaluate the impact of AVM treatment on headache intensity through a systematic review and meta-analysis.

Background Arteriovenous malformations (AVMs) are abnormal connections between cerebral arteries and veins that lack an intervening capillary bed. Brain AVMs affect approximately 0.1% of the population and are diagnosed in 1.3 per 100,000 individuals annually, with equal prevalence among sexes. While intracerebral hemorrhage (ICH) is the most common presentation, accounting for 50% of cases, headaches are also reported in 17–50% of patients, sometimes occurring before any bleeding occurs. These headaches may resemble migraines and often meet the diagnostic criteria for AVM-related headache as outlined in ICHD-3. Occipital AVMs, in particular, are linked to prominent visual symptoms and migraine-like features. Despite numerous reports connecting AVMs with headaches, the underlying pathophysiologic mechanism of this link remains speculative.

Design/Methods A search of three databases up to September 2023 identified 15 eligible studies with 1,459 patients. Treatment options included embolization, stereotactic radiosurgery, surgical resection, or combinations of these. Significant heterogeneity (I² = 57%, p = 0.003) required a random-effects model.

Results

The pooled analysis showed a significant reduction in headaches after treatment (pooled OR = 0.25; 95% CI: 0.17–0.36; p < 0.00001). Some studies demonstrated headache relief in 38–100% of treated patients, while others reported worsening outcomes. Sensitivity analysis confirmed result stability.

Conclusions These results support a strong therapeutic benefit of AVM intervention for headache relief and provide valuable prognostic information for clinicians and patients considering treatment, especially when headaches are a primary concern.

Authors/Disclosures
Amr Salem, MBBCH PRESENTER	Dr. Salem has nothing to disclose.
Sangharsha Thapa, MD	Dr. Thapa has nothing to disclose.
Sangam Shah (Tribhuvan University, Institute of Medicine)	Dr. Shah has nothing to disclose.
Anish Thapa, MBBS	Dr. Thapa has nothing to disclose.
Wilbert S. Aronow, MD	Dr. Aronow has nothing to disclose.

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