Published Online
on December 16, 2004

A more recent version of this article appeared on February 1, 2005

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Submitted on July 17, 2004
Revised on October 18, 2004
Accepted on October 26, 2004

Headache at Stroke Onset in 2196 Patients With Ischemic Stroke or Transient Ischemic Attack

Susanne Tentschert MD; Romana Wimmer MD; Stefan Greisenegger MD; Wilfried Lang MD; and Wolfgang Lalouschek MD^*

From the University Clinic of Neurology (ST, RW, SG, WL), Clinical Department of Clinical Neurology, University of Vienna; and the Neurological Department (WL), Hospital Barmherzige Brueder, Vienna, Austria.

^* To whom correspondence should be addressed. E-mail: wolfgang.lalouschek{at}meduniwien.ac.at.

Background and Purpose--Headache is a common symptom in acute ischemic and hemorrhagic stroke, but many aspects of its association with other clinical factors are controversial.

Methods--We analyzed characteristics of headache symptoms at stroke onset and associations between headache at stroke onset and at several clinical parameters in 2196 patients experiencing ischemic stroke or transient ischemic attack within a multicenter hospital-based stroke registry.

Results--Five hundred eighty-eight (27%) patients experienced headache at stroke onset. In a multivariate analysis, headache at stroke onset was positively associated with female sex, history of migraine, younger age, cerebellar stroke (but not with other brain stem locations), and blood pressure values on admission <120 mm Hg systolic and <70 mm Hg diastolic. It showed no significant association with stroke severity measured by the modified Rankin Scale at days 5 to 7 after the event, presumed etiology, or time of day.

Conclusions--Our results, derived from a large number of systematically documented patients with acute ischemic cerebrovascular events, show no association of headache with stroke etiology or outcome. Our results indicate that the previously described association of headache with vertebrobasilar stroke is mainly because of its association with cerebellar stroke. We could confirm previously described associations of headache at stroke onset with younger age and a history of migraine, implicating a careful evaluation of young patients with a focal neurological deficit and a history of migraine to avoid misclassification as "complicated migraine."

Key words: headache • stroke, ischemic • stroke onset

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