Headache After Coil Embolization for Unruptured Intracranial Aneurysms (Non‐Stent‐Assisted Versus Stent‐Assisted): A Prospective Comparative Cohort Study

BACKGROUND: The worsening of headaches or the occurrence of new headaches can occur after coil embolization. Although the frequency of headaches is reported to be greater when a stent is used, this phenomenon is poorly understood. Therefore, we aimed to evaluate the incidence and intensity of headache in patients treated with non-stent-assisted coil embolization (NSCE) versus stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs). METHODS: In this prospective comparative cohort study, a total of 186 patients treated with coil embolization for UIAs between June 2018 and March 2022 were classified into NSCE or SACE groups. A Cox proportional hazards model was used to identify risk factors for occurrence of headache, and changes in headache intensity over time were assessed using a linear mixed-effects model. RESULTS: Headaches occurred in 71.0% (132/186) of patients after coil embolization. During the 3-month follow-up, headaches after coil embolization were more common in patients who underwent SACE (adjusted hazard ratio, 1.57; p = 0.02). Female sex, cilostazol medication use, and pre-existing headache were also independently associated with the occurrence of headache after coil embolization. Changes in numeric rating scale (NRS) scores according to stent placement status and trends in NRS scores over time based on stent placement status were not statistically significant. CONCLUSIONS: Patients treated with SACE were more likely to experience headache after coil embolization than those treated with NSCE were. However, changes in headache intensity over time were not significantly different between the groups.