title: Concomitant headache influences long-term prognosis after acute cerebral ischemia of noncardioembolic origin.
abstract: OBJECTIVE
  Acute cerebral ischemia is frequently associated with headache. It is unknown whether concomitant headache reflects a partly different pathogenesis, and thus, may influence long-term prognosis after stroke. Here, we compared the long-term risk of recurrent vascular events in patients in whom a transient ischemic attack or minor ischemic stroke of noncardioembolic origin was associated with headache with those without headache.
  
  
  METHODS
  We used data from the Life Long After Cerebral ischemia (LiLAC) cohort. Participants were grouped on the basis of presence or absence of headache at presentation. We calculated the hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for any first vascular event (primary outcome) or any cardiac or cerebral event (secondary outcomes). Adjustments were made for baseline clinical characteristics.
  
  
  RESULTS
  Of 2473 participants, 420 (17%) experienced headache during the acute event. Median follow-up was 14.1 years. For the primary outcome, the crude HR of headache versus no headache was 0.75 (95% CI, 0.66-0.89) and the adjusted HR 0.83 (95% CI, 0.71-0.97). For cardiac events the adjusted HR was 0.88 (95% CI, 0.67-1.14) and for cerebral events, 0.97 (95% CI, 0.76-1.24). The ratio of cardiac versus cerebral events, however, did not differ between the 2 groups. Participants with headache were at lower risk of vascular death (adjusted HR, 0.73; 95% CI, 0.61-0.87).
  
  
  CONCLUSIONS
  Patients who experienced headache in association with a transient ischemic attack or minor ischemic stroke have a better vascular prognosis than those without concomitant headache. This may, at least partly, reflect a different pathogenesis.
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Maino
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Zwet
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000150:complications* / Q000453:epidemiology*; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors
keywords: cohort studies; headache; headache disorders, secondary; prognosis; stroke