Exploring the spectrum of headaches in neurocysticercosis: a systematic review and meta-analysis

Ravindra Kumar Garg; Imran Rizvi; Raza Abbas Mahdi; Ravi Uniyal; Vinay Suresh

doi:10.1093/trstmh/traf066

Exploring the spectrum of headaches in neurocysticercosis: a systematic review and meta-analysis

Trans R Soc Trop Med Hyg. 2025 Jun 27:traf066. doi: 10.1093/trstmh/traf066. Online ahead of print.

Authors

Ravindra Kumar Garg¹, Imran Rizvi², Raza Abbas Mahdi³, Ravi Uniyal², Vinay Suresh²

Affiliations

¹ Department of Neurology, Era's Lucknow Medical College and Hospital, Era University, Lucknow, India 226003.
² Department of Neurology, King George's Medical University, Lucknow, India 226003.
³ Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

PMID: 40574726
DOI: 10.1093/trstmh/traf066

Abstract

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.

Keywords: Teania solium; cephalgia; cysticercosis; headache; migraine.

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