title: Headache in acute ischaemic stroke: a lesion mapping study.
abstract: Headache is a common symptom in acute ischaemic stroke, but the underlying mechanisms are incompletely understood. The aim of this lesion mapping study was to identify brain regions, which are related to the development of headache in acute ischaemic stroke. Patients with acute ischaemic stroke (n = 100) were assessed by brain MRI at 3 T including diffusion weighted imaging. We included 50 patients with stroke and headache as well as 50 patients with stroke but no headache symptoms. Infarcts were manually outlined and images were transformed into standard stereotaxic space using non-linear warping. Voxel-wise overlap and subtraction analyses of lesions as well as non-parametric statistics were conducted. The same analyses were carried out by flipping of left-sided lesions, so that all strokes were transformed to the same hemisphere. Between the headache group as well as the non-headache there was no difference in infarct volumes, in the distribution of affected vascular beds or in the clinical severity of strokes. The headache phenotype was tension-type like in most cases. Subtraction analysis revealed that in headache sufferers infarctions were more often distributed in two well-known areas of the central pain matrix: the insula and the somatosensory cortex. This result was confirmed in the flipped analysis and by non-parametric statistical testing (whole brain corrected P-value < 0.01). To the best of our knowledge, this is the first lesion mapping study investigating potential lesional patterns associated with headache in acute ischaemic stroke. Insular strokes turned out to be strongly associated with headache. As the insular cortex is a well-established region in pain processing, our results suggest that, at least in a subgroup of patients, acute stroke-related headache might be centrally driven.
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany c.seifert@lrz.tu-muenchen.de.
authors.forename: Christian L
authors.initials: CL
authors.lastname: Seifert
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany 2 Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Etienne M
authors.initials: EM
authors.lastname: Schönbach
authors.affiliation: 3 Department of Neurology, University Hospital Basel, Switzerland 4 Medical Image Analysis Centre, c/o University Hospital Basel, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Magon
authors.affiliation: 3 Department of Neurology, University Hospital Basel, Switzerland.
authors.forename: Elena
authors.initials: E
authors.lastname: Gross
authors.affiliation: 5 Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: 5 Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Förschler
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Tölle
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany 6 TUM-Neuroimaging Centre, Klinikum rechts der Isar, Technische Universität München, Germany 7 Munich Cluster for Systems Neurology (SyNergy), München, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Mühlau
authors.affiliation: 3 Department of Neurology, University Hospital Basel, Switzerland 4 Medical Image Analysis Centre, c/o University Hospital Basel, Switzerland 8 Department of Neurology, DKD Helios Klinik, Wiesbaden, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Sprenger
authors.affiliation: 1 Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Poppert
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006261:Headache / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013003:Somatosensory Cortex / Q000473:pathology*; D020521:Stroke / Q000150:complications / Q000473:pathology*
keywords: MRI; headache; ischaemic stroke; lesion mapping