Stroke, Vol 24, 1621-1624, Copyright © 1993 by American Heart Association
K Vestergaard, G Andersen, MI Nielsen and TS Jensen
BACKGROUND AND PURPOSE: The etiology of headache in stroke is not known,
and its relation to migraine and tension-type headache is unclear. The aim
of our study was to investigate and classify headache appearing in stroke
patients prospectively, using the new headache classification as determined
by the Headache Classification Committee of the International Headache
Society (1988). METHODS: Two hundred eighty consecutively admitted patients
aged younger than 81 years with acute stroke were examined and questioned
about headache and prior headache complaints; 238 (85%) were able to
communicate. RESULTS: Sixty- five (27%) of the 238 patients experienced
headache from 3 days before to 3 days after stroke. Headache occurred in
50% of patients with intracerebral hemorrhage, in 26% with infarction, and
in 15% of patients with lacunar infarction. Headache was more common when
stroke occurred in posterior circulation than anterior circulation (P <
.02). Fifty-six patients were able to give further information about
headache characteristics. The headache in thromboembolic stroke was
classified as tension-type headache (25 patients), migraine-like headache
(14 patients), and other headache (12 patients). Migraine was more frequent
in vertebrobasilar stroke. Headache was lateralized in 33% of cases. In
patients with unilateral headache and unilateral stroke lesion, the
headache was ipsilateral in 14 of 17 cases. In infarction, severity of
headache showed no relation to lesion size or lesion localization. Patients
with previous tension-type headache and migraine experienced reactivation
of known headache equally often. CONCLUSIONS: (1) Headache occurs in one
fourth of patients with acute stroke. (2) Unilateral headache is usually
ipsilateral to stroke lesion. (3) Headache severity is not related to size
of ischemic stroke lesion.
ARTICLES
Headache in stroke
Department of Neurology, Aalborg Hospital, Denmark.
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