Headache at stroke onset in 2196 patients with ischemic stroke or transient ischemic attack.
OBJECTIVE
Headache is a common symptom in acute ischemic and hemorrhagic stroke, but many aspects of its association with other clinical factors are controversial.


METHODS
We analyzed characteristics of headache symptoms at stroke onset and associations between headache at stroke onset and at several clinical parameters in 2196 patients experiencing ischemic stroke or transient ischemic attack within a multicenter hospital-based stroke registry.


RESULTS
Five hundred eighty-eight (27%) patients experienced headache at stroke onset. In a multivariate analysis, headache at stroke onset was positively associated with female sex, history of migraine, younger age, cerebellar stroke (but not with other brain stem locations), and blood pressure values on admission <120 mm Hg systolic and <70 mm Hg diastolic. It showed no significant association with stroke severity measured by the modified Rankin Scale at days 5 to 7 after the event, presumed etiology, or time of day.


CONCLUSIONS
Our results, derived from a large number of systematically documented patients with acute ischemic cerebrovascular events, show no association of headache with stroke etiology or outcome. Our results indicate that the previously described association of headache with vertebrobasilar stroke is mainly because of its association with cerebellar stroke. We could confirm previously described associations of headache at stroke onset with younger age and a history of migraine, implicating a careful evaluation of young patients with a focal neurological deficit and a history of migraine to avoid misclassification as "complicated migraine."
Tentschert
Susanne
S
University Clinic of Neurology, Clinical Department of Clinical Neurology, University of Vienna, Austria.
Wimmer
Romana
R
Greisenegger
Stefan
S
Lang
Wilfried
W
Lalouschek
Wolfgang
W
D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis; D015233:Models, Statistical; D015999:Multivariate Analysis; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000473:pathology*