Headache Outcomes After Treatment of Cerebral Arteriovenous Malformations: A Systematic Review and Meta-Analysis with Clinical Implications.

Arteriovenous malformations (AVMs) are abnormal connections between cerebral arteries and veins that lack an intervening capillary bed. Brain AVMs affect approximately 0.1% of the population and are diagnosed in 1.3 per 100,000 individuals annually, with equal prevalence among sexes. While intracerebral hemorrhage is the most common presentation, accounting for 50% of cases, headaches are also reported in 17-50% of patients, sometimes occurring before any bleeding occurs. These headaches may resemble migraines and often meet the diagnostic criteria for AVM-related headache as outlined in intracerebral hemorrhage D-3. Occipital AVMs, in particular, are linked to prominent visual symptoms and migraine-like features. Despite numerous reports connecting AVMs with headaches, the underlying pathophysiologic mechanism of this link remains speculative. Treatment options for AVMs include embolization, stereotactic radiosurgery, surgical resection, or combinations of these. While some studies show headache relief in 38-100% of treated patients, others report worse outcomes. To address these inconsistencies, we conducted a systematic review and meta-analysis to measure the impact of AVM treatment on headache intensity. A search of 3 databases up to September 2023 identified 15 eligible studies with 1459 patients. Significant heterogeneity (I² = 57%, P = 0.003) required a random-effects model. The pooled analysis showed a significant reduction in headaches after treatment (pooled odds ratio = 0.25; 95% confidence interval, 0.17-0.36; P < 0.00001). These results support a strong therapeutic benefit of AVM intervention for headache relief and provide valuable prognostic information for clinicians and patients considering treatment, especially when headaches are a primary concern.