Association between migraine and headache attributed to stroke: a case-control study.
BACKGROUND
Several studies were carried out to investigate the occurrence of headache attributed to acute stroke in patients with a lifetime history of migraine.


METHODS
In a case-control series of 96 acute stroke patients with a lifetime history of migraine (M+) and 96 stroke patients without (M-), ischemic stroke patients only, without secondary infarction, were selected. The headache attributed to acute ischemic stroke was then analyzed.


RESULTS
(M+) patients complained of headache more often than (M-) patients (P < .0001), mainly in the 24 hours before stroke onset (P < .0001). Migraine-like features of headache were recognized in a greater proportion of cases in the (M+) patient group with ischemic stroke (P < .018). A preferential brainstem location of ischemic stroke in (M+) patients emerged compared with (M-) patients (P = .014).


CONCLUSIONS
The high prevalence of headache attributed to stroke in (M+) patients, in a relevant proportion of cases presenting as a sentinel headache, suggests that cerebral ischemia lowers the threshold for head pain more easily in these "susceptible" patients. The most frequent involvement of the brainstem in (M+) patients with ischemic infarction concurs with recent reports that emphasized a greater headache frequency when cerebral infarctions are localized in this structure or deep brain gray matter.
Nardi
Katiuscia
K
Neurologic Clinic, Department of Medical and Surgical Specialties and Public Health, University of Perugia, Italy.
Parnetti
Lucilla
L
Pieri
Maria L
ML
Eusebi
Paolo
P
Calabresi
Paolo
P
Sarchielli
Paola
P
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002545:Brain Ischemia / Q000453:epidemiology*; D020526:Brain Stem Infarctions / Q000150:complications; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology; D015897:Comorbidity; D005260:Female; D006261:Headache / Q000453:epidemiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology*; D015995:Prevalence; D020521:Stroke / Q000453:epidemiology*