The Post-Pipeline Headache: New Headaches Following Flow Diversion for Intracranial Aneurysm

Objective—Flow diversion using devices such as the “pipeline” stent is now a common treatment for
unruptured intracranial aneurysms. Though much is known about the efficacy of the device, less is reported
regarding potential side effects. In this study, we report the frequency and characteristics of the “post-pipe‐
line headache.”
Methods—We prospectively enrolled a cohort of 222 patients who underwent pipeline stenting for the
treatment of intracranial aneurysm between 2015 and 2018. A follow-up telephone survey was conducted
with a mean 21.6 months postprocedure evaluating postprocedure headaches and previous headache his‐
tory. A post-pipeline headache was defined as a new headache or pain distinct from their prior headache
syndrome. Information was collected regarding patient demographics, headache characteristics, headache
history, and whether symptoms were ongoing. Logistic regression was used to determine factors associated
with post-pipeline headache and the risk of long-term headache persistence.
Results—Eighty-eight individuals were reached by phone for follow-up; 48 (55%) of whom reported a
new headache postprocedure. Patients experiencing post-pipeline headache were more likely to be young
(OR 0.9; 95% CI: 0.85–0.94) and have a history of prior headaches (OR 2.4, 95% CI: 1.02–5.81). Associ‐
ated motor (OR 6.1; 95% CI: 1.19–31.47), cognitive (OR 7.0; 95% CI: 081–60.33), visual (OR 5.4; 95%
CI: 1.05–27.89), and vestibular (OR 4.8; 95% CI: 1.14–20.23) symptoms were associated with ongoing
headache.
Conclusions—Post-pipeline headache is common, particularly in younger individuals with prior head‐
ache history, and has distinctive features. Symptoms can remit over time; however, two-thirds experience
ongoing headaches, particularly those with associated migrainous features.