Isolated headache and its association with characteristics and outcome of cerebral venous sinus thrombosis

Abstract

We aimed to evaluate the clinical characteristics and outcome, hospital stay, and intracranial hemorrhage (ICH) development of patients with cerebral venous sinus thrombosis (CVST) who presented with isolated headache. In a retrospective study, consecutive patients with a definite diagnosis of CVST referred to Namazi hospital (Shiraz University of Medical Sciences) from 2012 to 2016 were included. Clinical, radiological, and prognostic characteristics and outcome on discharge (using modified Rankin Scale (mRS)) were compared between the CVST patients who presented with isolated headache and other CVST patients through univariate analyses. The associations of isolated headache with poor outcome (mRS > 2), presence or development of ICH, and duration of hospital stay were assessed through multivariable analyses. Of the 174 patients, 45 (26.0%) presented with isolated headache. Presence of isolated headache was more frequent in men ( p value = 0.048) and patients with thrombophilia ( p value = 0.040). Lateral sinus involvement was more common in patients with isolated headache ( p value = 0.005). After adjustment for other variables, the isolated headache was significantly associated with shorter hospital stay (odds ratio (OR): 0.85, confidence interval (CI): 0.73–0.99) and lower risk of early ICH (OR: 0.314, CI: 0.132–0.749). Although poor outcome was significantly less frequent in patients with isolated headache on univariate analysis ( p value < 0.001), this association was not significant in multivariable analysis (OR: 0.324, CI: 0.035–2.985). CVST patients with isolated headache had lower ICH events and shorter hospital stay. CVST should be considered as a possible differential diagnosis in certain patients who present only with headache, particularly those with diffuse progressive headache, or underlying provocative conditions.

Cerebral venous sinus thrombosis might be under-diagnosed in the COVID-19 era

“…For example, a study in China shows that 13% of COVID-19 patients can present with headache [ 13 ], whereas headache is the most common symptom of CVST and can occur in up to 95% of all CVST patients. Also, up to 25% of CVST patients can present only with headache, without any other neurological symptoms and signs [ 11 , 14 , 15 ]. On the other hand, headache usually occurs early in the course of COVID-19 and subsides spontaneously [ 13 ], but is usually progressive in CVST.…”

Clinical Significance of D-dimer Level and Numeric Rating Scale with Amount of Sinus Involvement in Cerebral Sinus Thrombosis Patients

“…These significant results are supported by research conducted by Patil et al and Shakibajahromi et al, namely that if a patient's CVST involves more than one sinus, the headache felt will be more extensive and severe, and the sequelae and clinical outcomes will be more severe than single sinus involvement. 10,16 Thus, in the analysis of this study it was found that multiple sinus involvement was more likely to cause a more severe level of pain, both before and after therapy, but the results of changes in the NRS criteria loss a significant difference between these two groups of patients after analysis. This study result provides important insights for further understanding the influence of the number of sinuses involved on pain levels and response to therapy in CVST patients.…”

“…These significant results are supported by research conducted by Patil et al and Shakibajahromi et al, namely that if a patient’s CVST involves more than one sinus, the headache felt will be more extensive and severe, and the sequelae and clinical outcomes will be more severe than single sinus involvement. 10 , 16 …”