Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke

Abstract

Background Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache. Methods This prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache. Results Our previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%. Conclusions We suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity.

Persistent headache after first-ever ischemic stroke: clinical characteristics and factors associated with its development

“…All data were collected prospectively. The present study is a continuation of three previous studies about headache in first-ever ischemic stroke which described the prevalence of sentinel headache, headache at onset of first-ever ischemic stroke, their diagnostic criteria and associated factors [2][3][4]. A full description of the inclusion procedure has been published in the previous articles.…”

“…Its diagnosis and treatment seem to be overshadowed by other stroke sequelae that may in fact be less debilitating. We previously suggested diagnostic criteria for acute headache attributed to ischemic stroke that distinguish between a new type of headache and a previous headache with altered characteristics [2]. Both types are caused by the stroke and both can lead to persistent headache after stroke.…”

“…Acute headache attributed to stroke was determined using our validated proposed diagnostic criteria [2]. Persistent headache after a first-ever ischemic stroke was defined according to ICHD-3 as an acute headache attributed to ischemic stroke that persisted for 3 months [1].…”

Persistent headache after first-ever ischemic stroke: clinical characteristics and factors associated with its development

“…All data were collected prospectively. The present study is a continuation of three previous studies about headache in rst-ever ischemic stroke which described the prevalence of sentinel headache, headache at onset of rst-ever ischemic stroke, their diagnostic criteria and associated factors [2,3,4]. A full description of the inclusion procedure has been published in the previous articles.…”

“…We previously suggested diagnostic criteria for acute headache attributed to ischemic stroke that distinguish between a new type of headache and a previous headache with altered characteristics [2].…”