6.3.3 Headache attributed to dural arteriovenous fistula (DAVF)

Diagnostic criteria:
  1. Any new headache fulfilling criterion C
  2. A dural arteriovenous fistula (DAVF) has been diagnosed
  3. Evidence of causation demonstrated by at least two of the following:
    1. headache has developed in close temporal relation to other symptoms and/or clinical signs of DAVF, or has led to the diagnosis of DAVF
    2. either or both of the following:
      • – headache has significantly worsened in parallel with other symptoms or clinical or radiological signs of growth of the DAVF
      • – headache has significantly improved or resolved after effective treatment of the DAVF
    3. at least one of the following:
      • – headache is accompanied by pulsatile tinnitus
      • – headache is accompanied by ophthalmoplegia
      • – headache is both progressive and worse in the morning and/or during coughing and/or bending over
    4. headache is localized to the site of the DAVF
  4. Not better accounted for by another ICHD-3 diagnosis1.
Note:

In particular, intracerebral haemorrhage and cerebral venous thrombosis have been excluded by appropriate investigations.

Comment:

Studies devoted to 6.3.3 Headache attributed to dural arteriovenous fistula are lacking. A painful pulsatile tinnitus can be a presenting symptom, as well as headache with features of intracranial hypertension due to decrease in venous outflow and sometimes to sinus thrombosis. Carotidocavernous fistulae may present as painful ophthalmoplegia.