Role of aneurysmal hemodynamic changes in pathogenesis of headaches associated with unruptured cerebral aneurysms

OBJECTIVE One symptom commonly associated with the presence of unruptured intracranial aneurysms is headache. In this study, the authors aimed to analyze factors associated with headaches among patients with intracranial aneurysms, with special consideration of hemodynamic parameters. METHODS The authors prospectively included 96 patients with 122 unruptured intracranial aneurysms. The authors obtained detailed medical history including current diseases and medications, as well as blood pressure values taken during hospitalization from the patients’ medical records. The short-form McGill Pain Questionnaire was administered to each patient at admission and 3–6 months after the procedure to assess type and severity of headache. Based on imaging data, the authors obtained 3D reconstruction of each patients’ aneurysm dome with feeding artery. The authors performed computational fluid dynamics analysis of blood flow through prepared models using OpenFOAM. Blood was modeled as Newtonian fluid, using the incompressible transient solver. Patient-specific internal carotid artery (ICA) blood velocity waves obtained with Doppler ultrasound were set as inlet boundary conditions. After performing simulation, the authors calculated the hemodynamic parameters of the aneurysm dome. RESULTS A total of 30 patients (31.25%) reported having headaches. In multivariate logistic regression analysis, female sex (OR 2.81, 95% CI 2.51–4.86; p < 0.01), ICA aneurysm location (OR 7.93, 95% CI 5.51–8.52; p < 0.01), multiple aneurysms (OR 6.05, 95% CI 1.83–11.83; p = 0.02), mean dome blood velocity (OR 3.10, 95% CI 2.01–3.30; p < 0.01) and time-averaged wall shear stress (OR 1.18, 95% CI 1.47–2.72; p = 0.04) were independently associated with the presence of headache. Additionally, 17 patients (56.67%) reported complete relief of symptoms after the procedure. In multivariate logistic regression analysis, the mean blood flow in the ICA was independently associated with complete resolution of headaches after aneurysm treatment (OR 2.32, 95% CI 1.57–3.28; p < 0.01). CONCLUSIONS Hemodynamic parameters of intracranial aneurysms might be associated with headaches and their relief after aneurysm treatment.