Dipyridamole-associated headache in stroke patients--interindividual differences?
BACKGROUND
Secondary pharmacological prevention of ischemic stroke or transient ischemic attack (TIA) is often provided with acetylsalicylic acid (ASA), dipyridamole (DP) or a combination of the two. A problem with DP is the occurrence of headache, sometimes leading to medication cessation. By using a titration regime of DP the incidence of headache gets lower. However, there are no studies on interindividual differences in the incidence of headache with regard to age, gender, localization of stroke and the number of days since stroke onset.


METHODS
20 stroke units in Sweden recruited newly diagnosed stroke and TIA patients in need for thrombocyte antiaggregating therapy. They were offered a titration regime of the combination ASA 25 mg + DP 200 mg once daily for 5 days followed by twice daily. Baseline characteristics of the patients were recorded and headache symptoms were filled in by each patient in a diary for 10 consecutive days. Rescue medication with paracetamol was optional.


RESULTS
174 ischemic stroke patients with a mean age of 70.3 years, 63% men and 37% women, were recruited. Headache of any kind was reported in 70 patients (40.2%) and 37 (21.3%) assessed the headache as moderate/severe. Six patients stopped medication due to headache. A subsiding character of the headache was found with a mean of 3.1 days. Patients with TIA had a significantly higher risk of getting headache compared to manifest stroke, regardless of localization. There was a trend towards higher risk in younger age groups and females. No effect was seen on the number of days since stroke onset.


CONCLUSIONS
DP is often associated with subsiding headache, however, with only few patients stopping medication due to headache. Being a younger female with a TIA seems to increase the risk of getting headache when having DP medication. Careful and adequate information about the possibly occurring headache should be given to patients prescribed a DP medication in order to increase compliance and optimize the pharmacological secondary stroke prevention.
Lökk
J
J
Institution of Neurobiology, Caring Sciences and Society, Karolinska Institutet; Geriatric Department, Karolinska University Hospital Huddinge, Stockholm, Sweden. johan.lokk@karolinska.se
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D004176:Dipyridamole / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012307:Risk Factors; D055502:Secondary Prevention; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control*; D013997:Time Factors; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000627:therapeutic use
D014665:Vasodilator Agents; D004176:Dipyridamole; D001241:Aspirin