Background: Symptomatic headaches attributed to unruptured brain arteriovenous malformations
(ubAVMs) are very common and affect patients’ quality life, but multidisciplinary care of ubAVMs to
improve symptomatic headache remains unclear.
Objective: The objective is to identify the features of symptomatic headaches, and to obtain
headache outcomes following multidisciplinary care of ubAVMs, as well as provide background on
the natural history of ubAVMs.
Study Design: The features of symptomatic headaches and headache outcomes were analyzed in
a large cohort of cases after multidisciplinary care of ubAVMs. We have also provided information
on the natural history of ubAVMs
Setting: This study was conducted at the Department of Neurosurgery of Zhujiang Hospital where
336 patients from 1998 to 2014 were reviewed by a multidiscipline team. Only 124 patients were
eligible.
Methods: The demographics, clinical features, imaging features, and headache details of eligible
patients were reviewed. An 11-point pain scale score was used to assess symptomatic headaches
before, during, and after treatment. The headache outcomes, death or stroke, and adverse functional
outcomes (modified Rankin Scale score ≥ 2, mRS ≥ 2) were assessed following multidisciplinary care
of ubAVMs.
Results: Twenty-three (56.1%) of 41 patients had migraine-like headaches located in occipital
lobe (P < 0.001), while forty (63.5%) of 63 patients had tension-type-like headaches located in
frontotemporal lobe (P < 0.001). For patients with tension-type-like or all types of headache,
headache improvement differed between the multidisciplinary group and medical group (87.8% vs.
31.8%, P < 0.001; 85.7% vs. 40.7%, P < 0.001). The risk of death or stroke did not differ between
multidisciplinary group and medical group (P = 0.393), whereas the risk of adverse functional
outcome (mRS ≥ 2) differed significantly by long-time follow-up (23.0% vs.10.0%, P = 0.022).
Limitations: This study provides the initial experience to support multidisciplinary care for ubAVMs
to improve symptomatic headaches and patients’ quality life, but based on the retrospective study
with inherent limitations, larger samples and multi-center trials are needed on this interesting issue.
Conclusions: Occipital ubAVM is more likely to present with migraine-like headache, while
frontotemporal ubAVM tends to present with tension-type-like headache. The effectiveness of
multidisciplinary care for ubAVM to improve headache has been shown, but the natural history of
ubAVM patients with headache remains unclear.
Key Words: Unruptured brain arteriovenous malformations, headache, headache improvement,
natural history