Ischemic Stroke Presenting as Thunderclap Headache: Report of Two Cases and Review of the Literature

Azevedo, Luiza Lopes; Breder, Raphael; Santos, Daniel Pinto de; Freitas, Gabriel R. de

doi:10.1159/000330675

Cited by 11 publications

(7 citation statements)

References 17 publications

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“…We used Mann-Whitney U-test to compare medians of nondichotomous variables at the acute (for the total sample) and the chronic stages (for the sample evaluated at 12 months) after stroke (age, NIHSS, mRS, and 15-GDS score) between patients with and without headache. For multivariable analysis of the predictors of headache at the chronic stage after stroke we performed a logistic regression, entering variables with a P < .05 on bivariate analysis (headache previous to stroke and gender) and predictors previously described in the literature [1][2][3][4][5][6][7][8][9][10][11] (age, severity of stroke and location of stroke). The same analysis was repeated controlling additionally for functional status at chronic stage and depressive symptoms at the chronic stage.…”

Section: Methodsmentioning

confidence: 99%

“…Headache is a common complaint of stroke survivors and it is better characterized in the acute stage . Headache in intracerebral hemorrhage survivors was reported as frequent and mostly as a tension‐type or migraine‐type headache .…”

Section: Introductionmentioning

confidence: 99%

“…Headache is a common complaint of stroke survivors and it is better characterized in the acute stage. [1][2][3][4][5][6][7][8] Headache in intracerebral hemorrhage survivors was reported as frequent and mostly as a tension-type or migraine-type headache. 9 Headache in ischemic stroke survivors after the acute stage is incompletely described.…”

Section: Introductionmentioning

confidence: 99%

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Headache at the Chronic Stage of Ischemic Stroke

et al. 2020

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Background Headache in ischemic stroke survivors after the acute stage is incompletely described. Objective We aimed to prospectively describe the characteristics of headache and the predictors of headache at the chronic stage after ischemic stroke. Methods We conducted a prospective observational cohort study including 102 acute ischemic stroke patients admitted to a Stroke Unit. Patients were interviewed at the acute and the chronic stage (12 months after stroke). Characteristics of those headaches were collected using a previously validated headache questionnaire enabling headache classification following the International Headache Society criteria. Pre‐stroke headache history was registered using the same instrument. Results Forty‐five patients out of 89 with completed follow‐up (51%) reported headache at the chronic stage. In most of the patients, headache was sporadic, mild, pressure‐like, with a duration of minutes to hours, with characteristics of tension‐type headache in 51% (n = 23/45). Headache was a reactivation of pre‐stroke headache in 33% (n = 15/45), different from pre‐stroke headache in 44% (n = 20/45), and of new‐onset in 22% (n = 10/45). Only 1 patient had a new‐onset headache at the acute stage that persisted with the same characteristics at the chronic stage. Pre‐stroke headache (OR = 5.3; 95% CI [2.01‐13.98] P = .001) and female sex (OR = 3.5; 95% CI [1.3‐9.4] P = .013) predicted headache at the chronic stage after stroke, controlling for age, severity, and location of stroke. Conclusions Headache in ischemic stroke survivors at the chronic stage is more frequent in women and in patients with pre‐stroke headache. It is most frequently a headache with different characteristics of the pre‐stroke headache and only rarely a new‐onset headache starting at the acute stage and persisting at the chronic stage.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Headache at the Chronic Stage of Ischemic Stroke

et al. 2020

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“…2 9 Rarely, thunderclap headache is caused by ischaemic stroke, which can be diagnosed on plain CT, although diffusion weighted MRI is better. 17 Hydrocephalus and brain tumours such as colloid cysts of the third ventricle occasionally present as repeated thunderclap headaches with nausea and vomiting, because of acute intracranial hypertension provoked by movements, coughing, or straining. 4 Thunderclap headache may be followed by coma due to herniation, and the diagnosis can usually be made on plain CT.…”

Section: Causes Detected By Plain Ct or Lumbar Puncturementioning

confidence: 99%

Thunderclap headache

Ducros

Bousser

2013

BMJ

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“…Of note, a small percentage of patients with IS can present acutely with migraine-like headache, mainly those with cervical artery dissection 50 and with posterior circulation ischemia. In our experience, patients rarely presented with thunderclap headache as the main opening symptom of an acute IS 51 . None of them had intracranial or extracranial vascular pathologies.…”

Section: Mimics or Secondary Migraine?mentioning

confidence: 60%

Migraine patients should be cautiously followed for risk factors leading to cardiovascular disease

Silva

Freitas

2013

Arq. Neuro-Psiquiatr.

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Migraine and ischemic strokes (IS) are two of the most prevalent diseases worldwide. Around 12 to 21% of women suffer migraine attacks and 2 in 1,000 per year people (older than 65 years-old) will have an acute ischemic stroke [1][2][3] . Therefore, frequently, neurologists and emergency medicine personnel face the challenge of dealing with symptoms that could be attributed to both pathologies, or even struggling to decide the best tests and therapy for the patient. Besides having some coincident symptomatology, for long researchers have been searching for a possible causal relation between these diseases, however the overlap of some risk factors makes the road even more tortuous. The aim of this review was not only to dissect some of the more compelling evidence based on data regarding this association, but also to discuss on how it would impact the clinical practice. We approached the subject in a problem-based fashion, discussing four of the most intriguing questions about the matter, always focusing on the clinical implications. In the end, we have introduced some diagnostic and therapeutic clinical pearls, presenting a stepped approach to difficult cases. CAN MIGRAINE BE A VASCULAR RISK FACTOR?The question about migraine being a risk factor for IS has been asked in several previous studies for the past half century. Two cohort studies 4,5 and three meta-analysis 6-8 consistently reported doubled risk for IS among migraine patients, with more robust evidence among young female patients with associated aura. This interesting observation would make us ABSTRACTMigraine and ischemic strokes are two of the most prevalent diseases worldwide. Besides having a coincident symptomatology, for long researchers have been searching for a possible causal relation between these diseases. Current evidence based on data suggest that patients with aura migraine could have a doubled risk of developing an ischemic stroke, when compared to the rest of the population. At the same time, migraine sufferers apparently have higher incidences of risk factors for cardiovascular events. The aim of this review was not only to dissect some of the more compelling evidence based on data regarding this association, but also to discuss the possible clinical and therapeutic implications.Key words: brain ischemia, cerebrovascular disorders, migraine, stroke. RESUMOMigrânea e acidentes vasculares cerebrais isquêmicos (AVCI) são duas das doenças de maior prevalência em todo o mundo. Além de apresentarem alguns sintomas em comum, há muito tempo pesquisadores procuram investigar uma relação causal entre as duas. As informações atuais baseadas em evidência sugerem que pacientes com migrânea com aura podem ter um risco duas vezes maior de desenvolver AVCI, quando comparados com o restante da população. Ao mesmo tempo, aqueles sofrem de migrânea possuem aparentemente maior incidência de fatores de risco para eventos cardiovasculares. O objetivo desta revisão foi não apenas avaliar grande parte das mais importantes e convincentes evidências científica...

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Ischemic Stroke Presenting as Thunderclap Headache: Report of Two Cases and Review of the Literature

Cited by 11 publications

References 17 publications

Headache at the Chronic Stage of Ischemic Stroke

Headache at the Chronic Stage of Ischemic Stroke

Thunderclap headache

Migraine patients should be cautiously followed for risk factors leading to cardiovascular disease

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