Analysis of risk factors associated with cerebral angiography headache

Despite previous studies indicating a moderate/high incidence of angiography headache (AH), there is still limited data about the risk factors associated with its occurrence.

Objective

The present study aimed to assess the associations among demographic, clinical, and technical characteristics of cerebral digital subtraction angiography (DSA) and the occurrence of AH.

Methods

Cross-sectional analytical observational study with a sample comprised of individuals with a recommendation for elective DSA. Clinical interviews were conducted to assess the occurrence of AH, using a standardized questionnaire.

Results

Among 114 subjects, the mean age was 52.8 (±13.8) years old, 75.4% (86/114) were women, 29.8% (34/114) had a history of migraines, and 10.5% (12/114) had chronic headaches. The overall frequency of AH was 45.6% (52/114). Of those, 88.4% (46/52) underwent 3D angiography, 7.7% (4/52) underwent aortography, and 1.9% (1/52) underwent both procedures. There was a statistically significant association between AH and previous history of migraine (odds ratio [OR]: 4.9; 95% confidence interval [CI] 1.62–14.7; p = 0.005) and 3D angiography (OR 6.62; 95%CI: 2.04–21.5; p = 0.002).

Conclusions

3D angiography is strongly associated with the occurrence of AH, which has never been reported before. The association between a previous history of migraine and AH confirms the results of previous studies.

Keywords:
Cerebral Angiography; Headache; Migraine Disorders; Headache Disorders, Secondary; Headache Disorders

Variables		Total	Angiography headache		p-value
Variables		Total	No	Yes	p-value
Participants		114 (100.0%)	62 (54.4%)	52 (45.6%)	–
Sex	Female	86 (75.4%)	40 (46.5%)	46 (53.5%)	0.003
Sex	Male	28 (24.6%)	22 (78.6%)	6 (21.4%)	0.003
Migraine	No	80 (70.2%)	52 (65.0%)	28 (35.0%)	< 0.0001
Migraine	Yes	34 (29.8%)	10 (29.4%)	24 (70.6%)	< 0.0001
Depression	No	89 (78.1%)	54 (60.7%)	35 (39.3%)	0.011
Depression	Yes	25 (21.9%)	8 (32.0%)	17 (68.0%)	0.011
Anxiety	No	84 (73.7%)	51 (60.7%)	33 (39.3%)	0.023
Anxiety	Yes	30 (26.3%)	11(36.7%)	19 (63.3%)	0.023
Hypertension	No	48 (42.1%)	32 (66.7%)	16 (33.3%)	0.025
Hypertension	Yes	66 (57.9%)	30 (45.5%)	36 (54.5%)	0.025
Mean contrast media volume ± SD (mL)		133.40 ± 40.72	145.38 ± 42.68	124.35 ± 37.13	0.022
		n = 109	n = 58	n = 51
Pressure injector	No	23 (21.1%)	20 (87.0%)	3 (13.0%)	< 0.0001
Pressure injector	Yes	86 (78.9%)	38 (44.2%)	48 (55.8%)	< 0.0001
3D Angiography	No	30 (27.5%)	24 (80.0%)	6 (20.0%)	0.001
3D Angiography	Yes	84 (73.7%)	38 (45.2%)	46 (54.8%)	0.001

Variables	Adjusted OR (95%CI)	p-value
Female sex	3.02 (0.99–9.2)	0.052
Hypertension	2.26 (0.89–5.7)	0.085
Diabetes mellitus	5.08 (0.98–26.2)	0.052
Depression and anxiety	3.74 (0.84–16.5)	0.082
Migraine	4.9 (1.62–14.7)	0.005
3D Angiography	6.62 (2.04–21.5)	0.002

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

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[1] Address for correspondence Tiago Madeira (email: tiagohiltonvmadeira@icloud.com).

Inclusion criteria	Age between 18 and 80 years old
	Men or women
	Cognition level that allows the analysis of the occurrence of AH
	Consent to the participation in the study, granted by signing an informed consent form
Exclusion criteria	Unstable clinical condition
	Need to use sedative medication to perform the DSA, regardless of type and dose
	Presence of disease and/or neurological sequelae that impair(s) the assessment of the occurrence of AH
	Patients who have presented a change in their clinical and/or neurological condition between the angiography and the post procedure interview with a current condition that makes it impossible to evaluate the occurrence of AH
	Indication for concomitant coronary and/or peripheral vascular angiography
	Patients who have not stopped using metformin for at least 48 hours prior the DSA
	Hemorrhagic or ischemic stroke in the last 90 days