Prevalence and risk factors of ischemic stroke-related headache in China: a systematic review and meta-analysis

Abstract

Background Headache accompanying ischemic stroke is considered an independent predictor of neurological deterioration. This meta-analysis aims to estimate the prevalence of ischemic stroke-related headaches and identify its risk factors in China. Methods PubMed, Embase, Cochrane Library database, Web of Science, PsycINFO, and four Chinese databases for the related publications were searched. Two researchers independently selected the literature, extracted the relevant data, and assessed its methodological quality. The meta-analysis applied a random-effects model with R software to calculate the pooled prevalence of ischemic stroke-related headaches in Chinese patients, and to merge the odds ratio (OR) of risk factors. Subgroup analysis, sensitivity analysis, and meta-regression analysis were conducted. Publication bias was assessed by a funnel plot and Egger test. Results Ninety-eight studies were eligible for inclusion. The overall pooled prevalence of ischemic stroke-related headache was 18.9%. Subgroup analysis showed that the prevalence of ischemic stroke related-headaches was higher among studies using self-report to diagnosis headache (18.9%; 95%CI, 8.9% to 40.2%), and those focused on age ≥ 55 years (19.7%; 95%CI, 14.9% to 25.9%), rural settings (24.9%; 95%CI, 19.7% to 31.6%). There were no significant differences in the headache prevalence between studies in the south and north, and inland and coastal studies. The prevalence of pre onset headache (13.9%) and tension-type headache (15.5%) and was higher compared with other types. History of headache (OR = 3.24; 95%CI, 2.26 to 4.65.), female gender (OR = 2.06; 95%CI, 1.44 to 2.96.), midbrain lesions (OR = 3.56; 95%CI, 1.86 to 6.83.), and posterior circulation stroke (OR = 2.13; 95%CI, 1.14 to 4.32) were major risk factors. Conclusion The prevalence of ischemic stroke-associated headache is high in China. In addition, women, presence of midbrain lesions, posterior circulation stroke and a history of migraine were high-risk factors for ischemic stroke-related headaches. Designing effective interventions to prevent or alleviated headaches is necessary to promote patients’ neurological recovery and quality of life.

Secondary headaches - red and green flags and their significance for diagnostics

“…A meta-analysis of >50 studies revealed that it can occur in 6% to 44% of ischemic stroke patients and usually associated with tension-type features [ 24 ]. Some of the risk factors identified include previous history of headache disorders, female, the presence of midbrain lesions and posterior circulation strokes [ [24] , [25] , [26] , [27] ]. Like PTH, persistent post-stroke headache occurs when the symptomatology lasts for more than three months and is usually associated with obstructive sleep apnea and other musculoskeletal abnormalities [ 28 ].…”

New management strategies for primary headache disorders: Insights from P4 medicine

“…Tertiary prevention can help patients reduce these long-term complications. For example, patients with MA have a higher risk for cardiovascular disease, ischemic stroke, and cognitive impairment [ [88] , [89] , [90] ]. TTH increases dementia risk [ 91 ].…”