Headache Is Common at the Onset of or Shortly Following Ischemic Stroke

Not only is headache common at the onset of or shortly following ischemic stroke, but headache may also contribute to poststroke morbidity, according to results of a new study.

“Better understanding of headache associated with ischemic stroke is needed to establish treatment guidelines and inform patient management,” the researchers wrote.

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To reach these conclusions, the researchers systematically reviewed 50 articles from Medline and PubMed, 20 of which were included in a meta-analysis and meta-regression. The studies comprised 11 European, 4 North American, and 5 Asian or Middle Eastern populations and had enrollment that ranged from 80 to 11,523 participants.

The prevalence of headache associated with ischemic stroke was between 6% and 44% in each study. According to the study authors, the overall prevalence suggests that approximately 14% of adult patients with ischemic stroke have headache at the time of or shortly following their stroke diagnosis. 

This prevalence is significantly associated with study location, the source population's national human development index, and study quality. For example, the prevalence of ischemic stroke-associated headache was higher in the studies with European and North American populations than in the studies with populations from the Middle East and Asia. Meanwhile, within each region, populations from countries with a higher human development index and studies with higher quality had lower prevalence. 

The risk of headache associated with ischemic stroke increased among women and patients who had posterior circulation stroke.

Most headaches that the study participants experienced had tension-type features, were moderate to severe, and became chronic in nature.

“That the headache often persists for months to years, can be continuous or daily, and can be moderate to severe in intensity implicate significant disability associated with [headache associated with ischemic stroke] and punctuate the need for evidence-based treatment approaches,” the researchers wrote. “The meta-analysis and systematic review also highlight the predominant patient-related phenotypes associated with [headache associated with ischemic stroke] including younger age, female sex, nonlacunar cortical stroke syndromes, and involvement of the posterior fossa.”

—Colleen Murphy

Reference:

Harriott AM, Karakaya F, Ayata C. Headache after ischemic stroke: a systematic review and meta-analysis. Neurology. 2020;94(1). https://doi.org/10.1212/WNL.0000000000008591.