Impact of Carotid Interventions on Headache Relief in Patients with Carotid Stenosis: a Retrospective Analysis of Carotid Endarterectomy Versus Stenting.

OBJECTIVE: To evaluate the impact of carotid endarterectomy (CEA) and carotid artery stenting (CAS) on postoperative headache outcomes in patients with carotid artery stenosis, comparing changes in pre-existing headache intensity and the incidence of new-onset headaches.

MATERIALS AND METHODS: We conducted a retrospective cohort analysis on 284 patients who underwent CEA (n=167) or CAS (n=117) between January 2018 and December 2023. Pre- and postoperative headache characteristics were documented at baseline and 24 h, 1 month, and 6 months after the intervention. We evaluated headache frequency, intensity (using the Numeric Rating Scale [NRS]), and duration while focusing on changes in pre-existing headaches and the incidence of new headaches.

RESULTS: Patients who underwent CEA had a greater reduction in headache intensity at 24 h (NRS median 4, Interquartile range [IQR]: 2-6) compared with those who underwent CAS (NRS median 6, IQR: 2-7; p=0.038). At 1 month, the CEA group continued to show lower headache scores (median 2, IQR: 1-3) compared with the CAS group (median 3, IQR 2-4; p=0.045). At 6 months, both groups had similar levels of headache resolution (p=0.785). Patients who underwent CAS had higher incidences of new-onset headache than those with CEA at 24 h (34.1% vs 20.3%; p=0.033) and 1 month (26.4% vs 13.1%; p=0.018), but converged by 6 months.

CONCLUSION: This study highlights the differential impacts of CEA and CAS on headache outcomes, with CEA showing a lower incidence and intensity of postoperative headaches. These findings underscore the need to consider patient-reported symptoms in treatment planning to enhance the quality of life. Further prospective research is essential to corroborate these observations and explore the mechanisms underlying headache outcomes after carotid interventions.