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

Abstract

Background and Purpose-The study aimed to assess whether onset headache is an ominous sign in patients with first-ever ischemic stroke. Methods-A large population of ischemic stroke patients was obtained from the Taiwan Stroke Registry. Stroke subtypes were classified by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. On the basis of the International Classification of Headache Disorders, second version, onset headache was defined as a new headache that developed at the onset of ischemic stroke. Clinical features and impact on stroke outcomes, including in-hospital stroke in evolution, changes in National Institutes of Health Stroke Scale on discharge, and Barthel index and modified Rankin scale ≤6 months after stroke were compared between those with and without onset headache. Results-Among 11 523 patients with first-ever ischemic stroke, 848 had onset headache (7.4%). Patients with specific cause, large-artery atherosclerosis, or cardioembolism were more likely to have onset headache. Patients with onset headache were younger, predominantly female, and more likely to have posterior circulation ischemic lesions. Compared with patients without onset headache, those with onset headache had a lower frequency of stroke in evolution (4.5% versus 6.7%; adjusted relative risk, 0.64; 95% confidence interval, 0. after stroke onset). [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. The present study sought to investigate the prevalence of onset headache in patients with first-ever ischemic stroke and assess its clinical significance using a nationwide prospective registration of stroke patients. Methods Data SourceThe Taiwan Stroke Registry (TSR) was a government-funded project that identified acute stroke admissions. Formally launched on August 1, 2006, it involved 39 academic and community hospitals diffusely covering the entire country, with 4 steps of quality control to ensure the reliability of entered data. All data were compiled prospectively by TSR-trained neurologists and study nurses, and all enrolled patients were visited by physiatrists, who started rehabilitation within 72 hours after admission. More than 42 000 patients with stroke were registered when the present study was undertaken. Approval of TSR as a human study protocol was obtained from the institutional review board of each participating hospital, and all subjects provided signed informed consents and permission for follow-up.The data collection, quality-assurance processes, and preliminary results of the stroke patient...

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

“…18 We did not observe such differences between the 2 groups. The clinical implication of headache at onset in patients with AIS is controversial and reported data are limited by small sample sizes.…”

“…18 Although the difference was not significant, our headache population showed potential toward a better outcome compared to the nonheadache cohort. This tendency was observed in univariate analysis only and may be attributed to the difference in age between the 2 groups.…”

Letter by Korn-Lubetzki Regarding Article, “Onset Headache Predicts Good Outcome in Patients With First-Ever Ischemic Stroke”

“…2 For this purpose, the authors defined anatomic localizations within the posterior circulation such as the cortex supplied by the posterior cerebral artery, thalamus, midbrain, pons, medulla, and cerebellum. 1 In this study, patients with onset headache were more likely to have ischemia in the posterior circulation, especially patients with cerebellar infarction. The conclusion was that onset headache was associated with modest but significantly better outcomes after ischemic stroke.…”

“…We read with interest the article by Chen et al 1 reporting that onset headache predicts better outcome in patients with first-ever ischemic strokes. The study was performed in a large cohort and showed interesting results.…”

“…This is in disagreement with our study in which we have shown that patients with brain stem-cerebellar stroke are less cardioembolic. In the study by Chen et al, 1 headache was correlated to stroke type or to the anatomic localization, but they did not address the stroke type within each anatomic localization. The clarification of this point might add value to the results.…”