Headache at the Chronic Stage of Ischemic Stroke

Abstract

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.

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

“…The occurrence of persistent headaches in our study was 10.4%, which is in accordance with previous studies [ 5 , 6 ]. However, only 1% of persistent headaches after stroke was found in a study which included persistent headaches at the chronic stage of ischemic stroke, average follow-up time was 15.6 months [ 7 ].…”

“…Other studies showed a higher prevalence of tension-type headaches [ 5 – 8 ]. One study demonstrated changes in characteristics of headaches from migraine-type to tension-type in almost half of stroke survivors at the chronic stage of ischemic stroke [ 7 ]. The authors of this study suspected that stroke had a modulating effect on the headache in most stroke survivors.…”

“…It was possible to detect this transformation thanks to the inclusion of patients with first-ever ischemic stroke and a clear description of headache characteristics at stroke onset. Other studies included patients with prior strokes which can produce persistent headaches and these headaches can interfere with the current headache caused by recurrent stroke [ 6 , 7 ].…”

Relevance of Cognition and Emotion for Patient-Reported Quality of Life After Stroke in Working Age: An Observational Cohort Study

“…This could be explained by our less severely affected stroke population. Post-stroke headache associated with ischemic stroke is poorly understood, only occurring in ~14% of patients ( 19 , 20 ). This underscores the importance to further explore headache associated with ischemic stroke to inform patient management.…”

Theoretically Based Factors Affecting Stroke Family Caregiver Health: An Integrative Review

“…The consequences of stroke are often debilitating and result in permanent disability for the stroke survivor. Some survivors experience physical symptoms such as aphasia, dysphagia, headaches, increased muscle tone, contractures, spasticity, hemiparesis, facial palsy, mobility, and balance issues (Carvalho Dias et al, 2020; Costa et al, 2016; Persson et al, 2020). Others may deal with cognitive and emotional impairments from direct damage to the brain.…”