A Multivariate Study of Headache Associated With Ischemic Stroke

Abstract

Thirty-four percent of 182 ischemic stroke patients registered during 1 year in a prospective hospital stroke data base complained of headache within a 72-hour interval of stroke onset. Headache was more common in patients under 70 years of age, in nonsmokers, in those with a past history of migraine, and in subjects presenting transient loss of consciousness, nausea/vomiting, or visual field defects. Headache was more frequent in vertebrobasilar (57%) than in carotid (20%) territory strokes, more so in posterior cerebral artery (90%) and cerebellar infarcts (80%), and was infrequent in subcortical infarcts (7%) and lacunes due to single perforator disease (9%). In multiple regression analysis, vertebrobasilar stroke (odds ratio 6.9), lacuanr stroke (odds ratio 0.06), and past history of migraine (odds ratio 6.7) were significant independent predictors of headache, suggesting that ischemic stroke location is the major determinant of stroke-associated headache, most probably related to activation of the trigeminovascular system, whose threshold may be modified by individual susceptibility.

Onset Headache Predicts Good Outcome in Patients With First-Ever Ischemic Stroke

“…Infarctions in the cerebellum, medulla, or posterior cerebral artery cortex are more likely to be associated with onset headache compared with other regions. The cerebellum and posterior cerebral artery cortex have been implicated in prior studies, 15,16 but the medulla is being reported for the first time, in the present study. Although the cerebellum is insensitive to pain, the vertebral artery and posterior inferior cerebellar arteries that supply both the medulla and cerebellum are sensitive to pain.…”

“…[6][7][8][9][10][11][12] Most previous studies do not specify these differences and as such, the frequencies of stroke-related headache vary from 8% to 34%. [1][2][3][4][8][9][10][11][12][13][14][15][16][17][18] In fact, stroke-related headache at different time points may result from different mechanisms and may have varying clinical effects. A large sample of patients with stroke-related headache in a well-defined time frame and a systematic follow-up of clinical features and outcomes are required to delineate the clinical impact of stroke-related headaches.…”

Post-IV thrombolytic headache and hemorrhagic transformation risk in acute ischemic stroke

“…4,[8][9][10][11][12][13][14][15][16] In addition, we found that patients who developed headaches after tPA administration were younger, which is consistent with a previous observation. 17 One previous study reported a higher incidence of headache in cardioembolic infarcts than in TIAs, lacunar infarcts, or thrombotic infarcts.…”

Cerebral Venous Thrombosis in the Absence of Headache

“…7 An inverse association between headache and age has been found in other cerebrovascular disorders. 8,9 Patients without headache also more often had seizures. Some of these patients might not recall a headache that occurred before the seizure.…”