Stroke-Related Headache Usually Begins on First Day

A new study has found that headache associated with acute stroke generally starts on the first day of the stroke and tends to be continuous; in more than half of the study patients, it also appears to be a reactivation of a previous primary headache.

Researchers from the University of Lisbon (Portugal) examined the duration, evolution, characteristics, and type of headache associated with stroke in 124 patients consecutively admitted to a stroke unit. Patients were interviewed daily from stroke onset until day 8 using a validated headache questionnaire, and were classified according to the International Headache Society (IHS) classification. Among the patients, 61% suffered from an ischemic stroke and 39% from a hemorrhagic stroke. The patients' median age was 58 years.

The study results showed that headache started on the first day of stroke in 107 patients (86%) and the mean headache duration was 3.8 days. Headaches were more often continuous and were more severe on the first day. The headache was more often bilateral and located in the anterior cranial region. The most frequently described quality was pressure and the most frequent type of headache met the criteria for tension-type (61%); 11% of headaches could not be classified using the IHS criteria. Overall, 40% of patients who reported headache also experienced nausea and vomiting. Headache severity increased with cough and with movement. Previous primary headache was documented in 71 patients, and reactivation of a previous headache was documented in up to half of the patients. The study was published in the April 2008 issue of Cephalalgia.

"One of the most interesting findings of our study is that stroke can reactivate previous lifetime headache,” said lead author Dr. Ana Verdelho, M.D., of the department of neurosciences. "So in these patients headache seems to be an entity that is reactivated by any brain insult and not specific for stroke. Continuous headache in patients without previous headache is probably a very useful symptom of brain lesion, and the IHS classification was difficult to use in these headaches.”

"I think we now have a better understanding of headache characteristics in the setting of acute stroke, and this fact is very useful in clinical practice. For instance, we have a prognosis of headache itself (in the setting of acute stroke),” concluded Dr. Verdelho.


Related Links:
University of Lisbon