Characterization of persistent headache attributed to past stroke

Abstract

Background Persistent headache attributed to past stroke (PHAPS) is a controversial entity, recently included in the third edition of the International Classification of Headache Disorders (ICHD-3) despite being described only in retrospective studies. Objective To determine the frequency and characteristics of PHAPS in patients admitted with acute stroke. Methods We selected all patients with headache associated with acute stroke (HAAS) from a prospective, single-center registry of patients with acute stroke admitted to a Neurology ward between November 2018 and December 2019. We analyzed demographic, clinical, and neuroimaging data. We assessed the follow-up with a phone call questionnaire at 6 to 12 months. Results Among 121 patients with acute stroke, only 29 (24.0%) had HAAS. From these, 6 (5.0%) were lost to follow-up. In total, 23 (20.0%) patients answered the 6- to 12-month follow-up questionnaire and were included in this study. The median age of the sample was 53 years (interquartile range [IQR]: 38–78 years), and there was no sex predominance. Of the 10 patients (8,3%) that had persistent headache, 8 (6.6%) suffered from previous chronic headaches; however, they all mentioned a different kind of headache, and 1 (0,8%) probably had headache secondary to medication. Conclusions In the present study, only 10 out of 121 stroke patients (8.3%) referred persistent headache at the 6- to 12-month follow-up, but the majority already suffered from previous chronic headache, which raises the question that the actual prevalence of PHAPS may be lower than previously reported.

Persistent headache attributed to past ischemic stroke: A prospective cohort study

“…Many of them jointly assessed patients with IS and hemorrhagic stroke, thereby not enabling an adequate comparison with our results. 4,6,9,17,18 The only study that was methodologically comparable with ours, which only included patients with IS and used the criterion diagnosis of ICHD-3, reported an incidence of 10.4%, which is similar to the present study. 10 Even if we were to disregard the losses and use the total sample, the incidence would still be considered high (5.4%).…”

“…Other studies have reported a frequency of headache in the late phase of stroke ranging from 7% to 51%. [4][5][6][8][9][10]17,18 These studies have used different methodologies, diagnostic criteria, and assessment intervals of patients after stroke, which ranged from 3 months to 3 years. Many of them jointly assessed patients with IS and hemorrhagic stroke, thereby not enabling an adequate comparison with our results.…”

“…[19][20][21] Having a primary headache was also a risk factor for persistent post-stroke headache in other studies. [8][9][10] Migraine causes a change in brain sensory processing 22 and is also a risk factor for other secondary headaches. [23][24][25][26] TA B L E 4 Assessment of risk factors for persistent headache attributed to past ischemic stroke.…”

“…This study did not adhere to the diagnostic criteria of ICHD-3 for PHAPIS, as it included patients with ischemic stroke and hemorrhagic stroke. 9 As far as we know, only one study has correctly used ICHD-3 criteria for the diagnosis of PHAPIS. This study included 550 patients with IS, and 3 months after the initial event, reported an incidence of PHAPIS of 10.4%.…”

“…One of these included 121 patients and reported an 8.3% incidence of PHAPIS. This study did not adhere to the diagnostic criteria of ICHD‐3 for PHAPIS, as it included patients with ischemic stroke and hemorrhagic stroke 9 …”