Concomitant Headache Influences Long-term Prognosis After Acute Cerebral Ischemia of Noncardioembolic Origin

Abstract

Background and Purpose-Acute cerebral ischemia is frequently associated with headache. It is unknown whether concomitant headache reflects a partly different pathogenesis, and thus, may influence long-term prognosis after stroke. Here, we compared the long-term risk of recurrent vascular events in patients in whom a transient ischemic attack or minor ischemic stroke of noncardioembolic origin was associated with headache with those without headache. Methods-We used data from the Life Long After Cerebral ischemia (LiLAC) cohort. Participants were grouped on the basis of presence or absence of headache at presentation. We calculated the hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for any first vascular event (primary outcome) or any cardiac or cerebral event (secondary outcomes). Adjustments were made for baseline clinical characteristics. Results-Of 2473 participants, 420 (17%) experienced headache during the acute event. Median follow-up was 14.1 years.For the primary outcome, the crude HR of headache versus no headache was 0.75 (95% CI, 0.66-0.89) and the adjusted HR 0.83 (95% CI, 0.71-0.97). For cardiac events the adjusted HR was 0.88 (95% CI, 0.67-1.14) and for cerebral events, 0.97 (95% CI, 0.76-1.24). The ratio of cardiac versus cerebral events, however, did not differ between the 2 groups. Participants with headache were at lower risk of vascular death (adjusted HR, 0.73; 95% CI, 0.61-0.87). Conclusions-Patients

Relation of post-stroke headachto cerebrovascular pathology and hemodynamics

“…That is why our results showed that post-stroke headache was more likely to occur within the first seven days post-stroke. These results were in agreement with a previous study, which revealed that post-stroke headache occurred mostly within the first 3-4 days post-stroke [19]. This could be also explained by the endothelial release of bradykinins, prothrombotic factors, glutamate, interleukin-6, nitric oxide metabolites, calcitonin gene-related peptides, substance P, and excitotoxic substances during the acute phase of ischemic stroke [13,18].…”

Headaches Attributed to Ischemic Stroke and Transient Ischemic Attack

“…This prospective cohort with 2473 patients monitored over a median period of 14.1 years observed a lower chance of vascular death in these patients (adjusted HR 0.73; 95% CI 0.68‐0.91). However, in this same study, the chance of a cerebrovascular event and myocardial infarction reoccurring was similar between the groups with and without headache . This cohort study was not originally designed to assess headache as a prognostic factor.…”

“…However, in this same study, the chance of a cerebrovascular event and myocardial infarction reoccurring was similar between the groups with and without headache. 44 This cohort study was not originally designed to assess headache as a prognostic factor. In addition, only minor ischemic strokes were included, which compromises its generalizability.…”

Headache after ischemic stroke

“…The prevalence of headache in the larger systematic review was within the range found in the meta-analysis. 4,6,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] ICHD-3 defines HAIS as either acute or persistent and if "headache has developed in very close temporal relation to other symptoms and/or clinical signs of ischemic stroke, or has led to the diagnosis of ischemic stroke." e61 Of the 16 studies that described the timing of headache assessment, 12 studies evaluated headache within 3-4 days of stroke symptoms, 6,15,20,22-25,30,35,49,e55,e57 and the remaining 4 within 8-14 days.…”

“…Prior studies report a wide range of prevalence of headache associated with ischemic stroke. [4][5][6] New-onset headache presenting at the time of acute ischemic stroke is a predictor of persistent headache 6 months after the stroke. 7 Indeed, headache after stroke has been characterized as a common form of chronic poststroke pain.…”