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Exploring the spectrum of headaches in neurocysticercosis: a systematic review and meta-analysis
Ravindra Kumar Garg1, Imran Rizvi2, Raza Abbas Mahdi3
1Department of Neurology, Era's Lucknow Medical College and Hospital, Era University, Lucknow, India 226003.
Background:
Understanding the prevalence, characteristics, diagnosis and management of headaches associated with neurocysticercosis (NCC) is essential for optimizing patient care.
Methods:
This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We examined case reports, case series and cohort studies that explored headaches in NCC patients. The review protocol was registered in PROSPERO (CRD42024530164).
Results:
A total of 53 isolated NCC cases presenting with headache and 8 cohort studies were included. Severe or progressive headaches, often resembling migraines, were most prevalent (35.2%). Brain parenchymal cysts were the most frequently observed lesion type (39.6%), followed by ventricular cysts (28.3%). Treatment primarily consisted of cysticidal therapy (66.2%), with surgical intervention required in 25.4% of cases. The majority of patients (96.2%) experienced clinical improvement. The meta-analysis addressed three key questions. Patients with primary headaches exhibited a significantly higher prevalence of calcified NCC (odds ratio [OR] 2.82, I2=0%). Likewise, primary headaches were more common in individuals with calcified NCC (OR 2.82, I2=0%). However, headache frequency (mean difference=1.93, I2=86%) and severity (mean difference=4.45, I2=99%) did not differ significantly.
Conclusions:
Brain parenchymal cysts, particularly ring or disk-enhancing colloidal cysts, may present with new-onset headaches mimicking primary headache syndromes. Our meta-analysis indicates a significant association between calcified NCC and primary headaches, but no substantial differences were found in headache frequency or severity.
