Dural arteriovenous fistulas and headache features: an observational study

Area of Science:

• Neurology
• Vascular Surgery
• Neurosurgery

Background:

• Dural arteriovenous fistulas (dAVFs) are intracranial vascular malformations with variable clinical courses, ranging from benign to fatal due to hemorrhage.
• Analysis of a 10-year single-institution experience focused on clinical presentation, headache features, and long-term outcomes of dAVFs.

Purpose of the Study:

• To analyze the clinical presentation, particularly headache characteristics, and long-term outcomes of intracranial dural arteriovenous fistulas.
• To differentiate clinical features between carotid-cavernous fistulas and other dAVFs based on headache and associated symptoms.

Main Methods:

• Retrospective collection of data from 40 patients (42 dAVFs) including demographics, medical history, clinical presentation, neuroimaging, and treatment.
• Utilized the modified-Rankin Scale (mRS) via telephone to assess long-term patient outcomes.

Main Results:

• Migraine-like headaches were a primary symptom in dAVFs (excluding carotid-cavernous fistulas), while non-migraine headaches were typical for carotid-cavernous fistulas (CCFs).
• Ocular symptoms were significantly more frequent in CCFs (92.9%) compared to other dAVFs.
• Seventy percent of patients reported no impact on quality of life at follow-up (mRS 0 or 1).

Conclusions:

• Headache characteristics and associated symptoms are linked to the location of dural arteriovenous fistulas.
• Non-migraine headaches accompanied by ocular symptoms should raise suspicion for carotid-cavernous fistulas.
• Migraine-like headaches may indicate other types of dural arteriovenous fistulas, offering insights into presentation symptoms.