Headache in classical hemophilia. The risk of diagnostic procedures.

Headache in a hemophiliac poses a major problem. The fact that at least half of hemophiliacs with proven intracranial hemorrhage present with a headache but no preexisting injury, requires an aggressive approach to the management of these patients. Recent articles point out successful instances of craniotomy in hemophilia, but relatively few hemophiliacs with headaches progress to that stage. We have reviewed the literature and added three cases in an attempt to establish the risk of spinal puncture and cerebral angiography in the evaluation of these patients. The data presented suggests that with replacement therapy and attention to angiographic technique, both procedures may be performed with minimal risk.