title: Role of atherosclerosis, clot extent, and penumbra volume in headache during ischemic stroke.
abstract: OBJECTIVE
  To investigate the role of large vessel atherosclerosis, blood clot extent, and penumbra volume in relation to headache in ischemic stroke patients.
  
  
  METHODS
  In this cross-sectional study, we performed noncontrast CT, CT angiography (CTA), and CT perfusion (CTP) in 284 participants from the Dutch Acute Stroke Study and Leiden Stroke Cohort within 9 hours after ischemic stroke onset. We collected headache characteristics prospectively using a semi-structured questionnaire. Atherosclerosis was assessed by evaluating presence of plaques in extracranial and intracranial vessels and by quantifying intracranial carotid artery calcifications. Clot extent was estimated by the clot burden score on CTA and penumbra volume by CTP. We calculated risk ratios (RRs) with adjustments (aRR) for possible confounders using multivariable Poisson regression.
  
  
  RESULTS
  Headache during stroke was reported in 109/284 (38%) participants. Headache was less prevalent in patients with than in patients without atherosclerosis in the extracranial anterior circulation (35% vs 48%; RR 0.72; 95% confidence interval [CI] 0.54-0.97). Atherosclerosis in the intracranial arteries was also associated with less headache, but this association was not statistically significant. Penumbra volume (aRR 1.08; 95% CI 0.63-1.85) and clot extent (aRR 1.02; 95% CI 0.86-1.20) were not related with headache.
  
  
  CONCLUSIONS
  Headache in the early phase of ischemic stroke tends to occur less often in patients with atherosclerosis than in patients without atherosclerosis in the large cerebral arteries. This finding lends support to the hypothesis that vessel wall elasticity is a necessary contributing factor in the occurrence of headache during acute ischemic stroke.
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands. h.j.a.van_os@lumc.nl.
authors.forename: Hendrikus J A
authors.initials: HJ
authors.lastname: van Os
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Inge A
authors.initials: IA
authors.lastname: Mulder
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Irene C
authors.initials: IC
authors.lastname: van der Schaaf
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Alexander
authors.initials: A
authors.lastname: Broersen
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Vos
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Gisela M
authors.initials: GM
authors.lastname: Terwindt
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Schonewille
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Marianne A A
authors.initials: MA
authors.lastname: van Walderveen
authors.affiliation: From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011795:Surveys and Questionnaires