Objective:

To evaluate the impact of AVM treatment on headache intensity through a systematic review and meta-analysis.

Background:

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 (ICH) 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 ICHD-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.

Design/Methods:

A search of three databases up to September 2023 identified 15 eligible studies with 1,459 patients. Treatment options included embolization, stereotactic radiosurgery, surgical resection, or combinations of these. Significant heterogeneity (I² = 57%, p = 0.003) required a random-effects model.

Results:

The pooled analysis showed a significant reduction in headaches after treatment (pooled OR = 0.25; 95% CI: 0.17–0.36; p < 0.00001). Some studies demonstrated headache relief in 38–100% of treated patients, while others reported worsening outcomes. Sensitivity analysis confirmed result stability.

 

Conclusions:

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.