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

Abstract

Background It is poorly described how often headache attributed to stroke continues for more than 3 months, i.e. fulfils the criteria for persistent headache attributed to ischemic stroke. Our aims were: 1) to determine the incidence of persistent headache attributed to past first-ever ischemic stroke (International headache society categories 6.1.1.2); 2) to describe their characteristics and acute treatment; 3) to analyse the prevalence of medication overuse headache in patients with persistent headache after stroke; 4) to evaluate factors associated with the development of persistent headache after stroke. Methods The study population consisted of 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke, among them 529 patients were followed up at least three months after stroke. Standardized semi-structured interview forms were used to evaluate these headaches during professional face-to-face interviews at stroke onset and telephone interviews at 3 months. Results At three months, 61 patients (30 women and 31 men, the mean age 60.0) of 529 (11.5%) follow-up patients had a headache after stroke: 34 had a new type of headache, 21 had a headache with altered characteristics and 6 patients had a headache without any changes. Therefore 55 (10.4%) patients had a persistent headache attributed to ischemic stroke. Their clinical features included: less severity of accompanying symptoms, slowly decreasing frequency and development of medication overuse headache in one-third of the patients. The following factors were associated with these headaches: lack of sleep (29.1%, p = 0.009; OR 2.3; 95% CI 1.2–4.3), infarct in cerebellum (18.2%, p = 0.003; OR 3.0; 95% CI 1.4–6.6), stroke of undetermined etiology (50.9%, p = 0.003; OR 2.3; 95% CI 1.3–4.1), less than 8 points by NIHSS score (90.9%, p = 0.007; OR 3.4; 95% CI 1.4–8.6) and low prevalence of large-artery atherosclerosis (12.7%, p = 0.006; OR 0.3; 95% CI 0.2–0.80). Conclusion Persistent headache attributed to ischemic stroke is not rare and frequently leads to medication overuse. The problem is often neglected because of other serious consequences of stroke but actually, it has a considerable impact on quality of life. It should be a focus of interest in the follow-up of stroke patients.

Persistent headache attributed to past cervicocephalic artery dissection: clinical characteristics and contributors to headache persistence

“…The HPCCAD is less documented in the literature, and few authors have studied its frequency (8,9); nevertheless, our work is in concordance with the findings of other studies in this field (8,9,(13)(14)(15). Schytz et al (8) showed that six months after dissection, five of 19 patients (26.3%) reported persistent headache attributable to the event.…”

“…Tentschert et al (17) showed that 23% of patients with a persistent headache for three years after a stroke had previous history of headache, and our study showed a percentage almost three times higher (63.6%). On the contrary, Lebedeva et al (15) did not find a high prevalence of previous headache among patients with persistent headache after stroke, once more possibly explained by fine distinction between current and previous headaches.…”

“…Also, Hansen et al, in a prospective cohort study with 275 patients with stroke of any etiology, showed that at three and six months, 23% and 23.4% of patients had a persistent headache post-stroke, respectively, and at three years 11.7% reported maintenance of this headache (13,14). On the other hand, Lebedeva et al (15), in a recent prospective study, found lower percentages for acute and persistent headaches after stroke: at three months, 61 of 529 (11.5%) patients had a headache after stroke, and 55 (10.4%) had a persistent headache attributable to ischemic stroke. One possible justification could be the fact that these authors consider that a headache at stroke onset with different characteristics from a pre-existing headache can fit into an attributedto-stroke headache, whereas if the characteristics are unchanged, they were not attributed to stroke.…”

“…Indeed, in our study, HPCCAD patients had a delay in diagnosis, with a symptom-diagnosis time twice as long as the control group, which may also have contributed to a delay in treatment and persistence of headache. Other studies also point out that medication overuse headache is frequent in patients with a persistent headache, which can contribute to the worsening and chronicity of this headache (15). Lebedeva et al showed that, although almost half of their patients had a migrainelike persistent headache after stroke, triptans were ineffective in these group, which may point to a different pathophysiology for the headache subtypes (15).…”

“…Other studies also point out that medication overuse headache is frequent in patients with a persistent headache, which can contribute to the worsening and chronicity of this headache (15). Lebedeva et al showed that, although almost half of their patients had a migrainelike persistent headache after stroke, triptans were ineffective in these group, which may point to a different pathophysiology for the headache subtypes (15).…”