Characteristics of headache associated with cerebral arteriovenous malformations

Background and purposes. The purpose of this study was to identify the spec ific characteristics of headaches associated with cerebral arteriovenous ma lformations in older to differentiate them from other known entities of hea daches such as migraine, cluster headache, and trigeminal neuralgia. This d ifferentiation allows an early diagnosis of cAVM and a treatment to be admi nistrated before any cerebral hemorrhage. Patients and methods. The study included 700 patients with cAVM and treated by radiosurgery. Out of this series, only 109 (48 males, 61 females, mean age of 33) presented with headaches. Headaches were studied as a possible r evelation mode of a cAVM, either as an isolated sign, preceding an epilepti c seizure, a celebral hemorrhage, or associated with a neurological deficit . Analysis concerned 13 clinical parameters and 30 anatomic parameters base d on angiography. Results. Headaches were found in 15.6 %; they were isolated in 6%. They pre ceded a cerebral hemorrhage in 12.6%, constituting an early alarm signal wh en increasing in intensity, frequency and duration. They were associated wi th seizures or a neurological deficit in 9.6 %. We found a predominant fema le sex-ratio (0.78) and occurrence at a young age (72.3 % between IO and 40 years). Headaches were non-pulsating in 95.3 %; nausea, vomiting light or sound phobia were only Sound in 4.7 %. Headaches were unilateral and homola teral to the malformation in 80 %, corresponding to the malformation topogr aphy, in 97.4 % in posterior location and 80% in anterior location. Associa ted neurological symptoms existed in 20.2 %; related to the malformation an d lasting 5 to 30 minutes. Duration of pain episodes was less than 3 hours in 77 % with a frequency of 1 to 2 per month in 82.5 %. Pain was mild and r esponded to simple analgesics. A family migraine was found in only 3 patien ts. The angiographic characteristics of the malformations were meningeal af ferences, superficial venous drainage and posterior location. Conclusions, Headaches associated with cerebral arteriovenous malformations form a distinct category that can he determined from specific characterist ics; this should help an early diagnosis of cerebral arteriovenous malforma tions in order to start a treatment before the occurrence of cerebral hemor rhage.