A Narrative Review of Persistent Post‐Stroke Headache – A New Entry in the International Classification of Headache Disorders, 3rd Edition

Lai, Joshua; Harrison, Rebecca; Plecash, Alyson; Field, Thalia S.

doi:10.1111/head.13382

Cited by 28 publications

(47 citation statements)

References 65 publications

(215 reference statements)

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“…2 In our study headache in the chronic stage after stroke was predicted by previous history of headache and by female sex, as reported by others, but we did not confirm other predictors as severity of stroke and location of the lesion. [10][11][12][13][14][15] It is possible that severity and location of the lesion are more associated with headache in hemorrhagic strokes. 9 Although headache in the chronic stage was more frequent in patients with headache at the acute stage, the later was not a predictor for headache at the chronic stage.…”

Section: Discussionmentioning

confidence: 99%

“…Stroke location was defined as anterior (medium cerebral artery and anterior cerebral artery), posterior (posterior cerebral artery, cerebellum and brainstem), or subcortical (thalamus, internal capsule lesions). We used this grouping of stroke locations, because headache at the acute stage of stroke is reported to be more frequent after strokes of posterior location and infrequent in subcortical infarcts . Results of ancillary procedures conducted to investigate stroke etiology were collected in standardized form by the team of neurologists working in the Stroke Unit, accordingly to the procedures of the Stroke Unit registry.…”

Section: Methodsmentioning

confidence: 99%

“…We used this grouping of stroke locations, because headache at the acute stage of stroke is reported to be more frequent after strokes of posterior location and infrequent in subcortical infarcts. 2,10 Results of ancillary procedures conducted to investigate stroke etiology were collected in standardized form by the team of neurologists working in the Stroke Unit, accordingly to the procedures of the Stroke Unit registry.…”

Section: Methodsmentioning

confidence: 99%

“…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%

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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: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Headache at the Chronic Stage of Ischemic Stroke

et al. 2020

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“…We speculate that, as a consequence of the organization of the infarction, there may be structural changes that causes stretching of pain sensitive structures and may also disrupt central pain pathways localized in brainstem, insula, or somatosensory cortex. Comorbid depression, fatigue, and sleep apnea may also play a role …”

Section: Pathophysiologymentioning

confidence: 99%

Headaches Attributed to Ischemic Stroke and Transient Ischemic Attack

Oliveira

Rocha-Filho

2019

Headache

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Introduction Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of cerebrovascular disease. Method This is a narrative review. Results The prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% of cases and of headache attributed to transient ischemic attack, from 26% to 36%. Headache attributed to ischemic stroke is more frequent in younger patients, in migraineurs, in those who have suffered a larger stroke, a posterior circulation infarction, or a cortical infarction, and is less frequent in lacunar infarctions. The most common pattern of headache attributed to ischemic stroke is a mild to moderate bilateral pain, not associated with nausea, vomiting, photophobia, or phonophobia. This headache usually has a concomitant onset with focal neurologic deficit and improves over time. The few studies that have assessed the value of headache for a prognosis of ischemic strokes have demonstrated conflicting results. There are no clinical trials on pain management or prophylactic treatment of persistent headache attributed to ischemic stroke. Conclusion Headache attributed to ischemic stroke is frequent and usually has a tension‐type headache pattern. Its frequency varies according to the stroke’s etiology. Further studies are required on pain management, prophylactic treatment, and characteristics of this headache.

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