Headaches Attributed to Ischemic Stroke and Transient Ischemic Attack

Abstract

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.

Headache at onset of first‐ever ischemic stroke: Clinical characteristics and predictors

“…Our results are in accordance with the literature [3] and showed that 15% of ischemic stroke patients had headache at the time of ischemic stroke onset. However, the previous studies did not analyze the exact time of development and disappearance of these headache, and did not have any simultaneous control groups.…”

“…Our results are in accordance with the literature [3] and showed that 15% of ischemic stroke patients had headache at the time of TA B L E 3 Types of headache on the day of stroke and the day of interview in controls Migraines with and without aura with altered characteristics and tension headache with altered characteristics, as well as migraines with and without aura and tension headache in the form of a new type of headache, were defined in the text as a migraine-like and tension-type-like headache, respectively, as they can be attributed to stroke.…”

“…Headache is an important symptom at onset of ischemic stroke because it can lead to severe persistent headache after stroke and can influence the prognosis of stroke [1,2]. The published prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% [3]. Despite several studies in this field, none has prospectively investigated headache at onset of first‐ever ischemic stroke along with a large concurrent control group to assess the relation of newly developed headache with stroke.…”

Headache in cerebrovascular diseases

“…In many of these conditions, such as ischaemic or haemorrhagic stroke, headache is overshadowed by focal signs and/or disorders of consciousness. Headaches associated with ischaemic stroke have no special features, which can be ipsilateral or bilateral, mild to moderate intensity and often recover within 3 months 2. It is more common in posterior circulation than in anterior circulation.…”

“…Headaches associated with ischaemic stroke have no special features, which can be ipsilateral or bilateral, mild to moderate intensity and often recover within 3 months. 2 It is more common in posterior circulation than in anterior circulation. In haemorrhagic stroke, headache is usually severe and torturous.…”