Course of Preexisting Migraine Following Spontaneous Subarachnoid Hemorrhage

José Manuel Valdueza; Jens Peter Dreier; Johannes Woitzik; Christian Dohmen; Oliver Sakowitz; Johannes Platz; Stefanie Leistner-Glaess; Victoria Dorothea Witt

doi:10.3389/fneur.2022.880856

Course of Preexisting Migraine Following Spontaneous Subarachnoid Hemorrhage

Front Neurol. 2022 Jul 11:13:880856. doi: 10.3389/fneur.2022.880856. eCollection 2022.

Authors

José Manuel Valdueza¹, Jens Peter Dreier^{2

3

4

5

6}, Johannes Woitzik^{2

7

8}, Christian Dohmen⁹, Oliver Sakowitz¹⁰, Johannes Platz¹¹, Stefanie Leistner-Glaess³, Victoria Dorothea Witt¹²

Affiliations

¹ Neurological Center, Segeberger Kliniken, Bad Segeberg, Germany.
² Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
³ Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
⁴ Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
⁵ Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany.
⁶ Einstein Center for Neurosciences Berlin, Berlin, Germany.
⁷ Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁸ Department of Neurosurgery, Evangelisches Krankenhaus, Carl-von-Ossietzky University, Oldenburg, Germany.
⁹ Department of Neurology, LVR-Hospital Bonn, Bonn, Germany.
¹⁰ Department of Neurosurgery, Neurochirurgische Universitätsklinik, Heidelberg, Germany.
¹¹ Department of Neurosurgery, Heart-Neuro-Center Bodensee, Münsterlingen, Switzerland.
¹² Psychiatric Center Rickling, Rickling, Germany.

Abstract

Background: Our objective was to observe the course of preexisting migraine following subarachnoid hemorrhage (SAH) in patients with and without craniotomy.

Methods: We designed an exploratory analysis and hypothesis-generating study of prospectively collected data starting by recruiting patients suffering from SAH with the Hunt and Hess scale score of ≤ 4. Out of 994 cases, we identified 46 patients with preexisting active migraine defined by at least four attacks in the year before SAH. According to the treatment, we subdivided the patients into two groups: the first group included patients with surgical aneurysm clipping with transection of the middle meningeal artery (MMA) and accompanying trigeminal nerve branches and the second group included patients with endovascular aneurysm coiling or without any interventional treatment. During the follow-up, we recorded the course of migraine frequency, duration, intensity, and character.

Results: For both groups (craniotomy n = 31, without craniotomy n = 15), a significant improvement regarding the preexisting migraine during a mean follow-up of 46 months (min. 12 months, max. 114 months) was seen regarding complete remission or at least >50% reduction in migraine attacks (p < 0.001 and p = 0.01). On comparing the groups, this effect was significantly more pronounced in patients with craniotomy (for no recurrence of migraine: p = 0.049). After craniotomy, 77.4% of the patients had no further attacks of migraine headache and 19.4% showed a reduction of >50% while only 2.2% did not report any relevant change. In the non-surgical group, 46.7% had no further migraine attacks, 20% had a reduction of >50%, while no change was noted in 33.3%.

Conclusions: Our study provides evidence that the dura mater might be related to migraine headaches and that transection of the MMA and accompanying trigeminal dural nerve branches might disrupt the pathway leading to a reduction of migraine attacks. However, coiling alone ameliorated migraine complaints.

Keywords: clipping; coiling; middle meningeal artery (MMA); migraine; subarachnoid hemorrhage (SAH); trigeminal nerve branches.