Clinical Implications of Headache in Lacunar Stroke: Relevance of Site of Infarct

Abstract

In patients with lacunar infarction, headache at stroke onset was more common in deep brain gray matter or brainstem topographies than in supratentorial white matter lesions. In deep brain gray matter or brainstem lacunar infarctions, early neurological recovery was less likely when headache was present.

Clinical characteristics of acute lacunar stroke in young adults

“…It has been shown that headache at lacunar stroke onset was more common in brainstem topographies than in supratentorial white matter lesions [47]. In addition, neurological recovery in brainstem lacunar infarctions is less likely when headache is present [22].…”

“…For each patient, demographic data, cardiovascular risk factors, clinical features, neuroimaging findings and early outcome were recorded. Although details of these of these variables have been reported in previous studies [9,21], the more common were alcohol abuse (history of alcohol ingestion of 60 g ethanol/day), heavy smoking (history of daily tobacco use [>20 cigarettes/day] at least in the 2 years prior to cerebral ischemia), obesity (presence of a BMI >30 kg/m 2 ), lacunar stroke of essential or unknown cause (presence of lacunar stroke in the absence of hypertension, diabetes or other cerebrovascular risk factors as well as in the absence of criteria of cerebral ischemic of cardioembolic origin, atherothrombotic cause or unusual etiology), lacunar stroke-related headache (presence of headache at stroke onset) [22], cardioembolic lacunar stroke (clinical manifestations compatible with a lacunar syndrome, presence of a recent subcortical infarct <20 mm of maximum lesional diameter related to the clinical syndrome, identification of an emboligenous heart disease in the absence of hypertension and/or diabetes and exclusion of carotid and/or cerebral atherosclerosis or other causes of stroke) [23], atypical lacunar syndrome (proven radiologically absence of one of the five classical lacunar syndromes and presence of another clinical syndrome [e.g., pure dysarthria, isolated hemiataxia, hemichorea-hemiballismus, etc.]) [24], and pure motor syndrome (presence of unilateral partial or complete paresis involving at least two of three areas [face, upper limb or lower limb] of the body and no evidence of aphasia, apraxia and agnosia, nor visual field defect, eye movement disturbance, ataxia, sensory loss or evidence of bilateral weakness) [25].…”

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

“…[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.…”

“…[1][2][3][4] The clinical significance of stroke-related headache remains uncertain because of the absence of systematic studies on large populations of stroke patients. On the basis of the International Classification of Headache Disorder, 2nd edition (ICHD-2), 5 headache attributed to ischemic stroke (code 6.1.1) is specified as any new acute headache that develops simultaneously with or in very close temporal relation to signs of ischemic stroke.…”

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

“…19,20 In contrast, 2 studies suggest that stroke patients with headache have lower frequencies of symptom-free rate on discharge than those without headache. 21,22 We tried to evaluate the influence of onset of headache in the setting of thrombolytic treatment on clinical outcomes. Although postthrombolytic headache may be an indicator of possible complications, especially when associated with neurologic worsening, in our study the presence of headache alone was not associated with worse outcomes or with increased risk of HT.…”