Acute headache attributed to ischemic stroke: assessment of its characteristics and associated factors

 

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Abstract

Background It is estimated that headache attributed to ischemic stroke occurs in 7.4% to 34% of the cases. Despite its frequency, this headache has been little studied in terms of its risk factors and characteristics.

Objective To assess the frequency and clinical characteristics of headache attributed to ischemic stroke and the factors associated with its occurrence.

Methods The present was a cross-sectional study which included patients consecutively admitted within 72 hours of the onset of ischemic stroke. A semi-structured questionnaire was used. The patients underwent magnetic resonance imaging.

Results A total of 221 patients were included, 68.2% of whom were male, and the mean age was of 68.2 ±  13.8 years. The frequency of headache attributed to ischemic stroke was of 24.9% (95% confidence interval [95%CI]: 19.6–31.1%). The headache had a median duration of 21 hours and most frequently began at the same time as the focal deficit (45.3%), with a gradual onset (83%). It was of moderate intensity, pulsatile (45.3%), bilateral (54.6%), and presented a similar pattern to that of tension-type headache (53.6%). Headache attributed to stroke was significantly associated with previous tension-type headache, and previous migraine with and without aura (logistic regression).

Conclusion Headache attributed to stroke is common, with a pattern similar to that of tension-type headache, and it is associated with a history of tension-type and migraine headaches.

Resumo

Antecedentes A cefaleia atribuída ao acidente vascular cerebral isquêmico (AVCi) tem uma frequência de 7,4% a 34% dos casos. Apesar de ser considerada frequente, esta cefaleia ainda é pouco estudada em termos de seus fatores de risco e características.

Objetivo Avaliar a frequência e as características clínicas da cefaleia atribuída ao AVCi e os fatores associados com a sua ocorrência.

Métodos Este foi um estudo transversal que incluiu pacientes admitidos consecutivamente com até 72 horas do início do AVCi. Foi utilizado um questionário semiestruturado. Os pacientes realizaram ressonância magnética.

Resultados Foram incluídos 221 pacientes, 68,2% dos quais eram do sexo masculino, e com idade média de 68,2 ±  13,8 anos. A frequência da cefaleia atribuída ao AVCi foi de 24,9% (intervalo de confiança de 95% [IC95%]: 19,6–31,1%). A duração mediana da cefaleia foi de 21 horas, e ela se iniciou com mais frequência ao mesmo tempo em que o déficit focal (45,3%), teve instalação gradual (83%), foi de moderada intensidade, pulsátil (45,3%), bilateral (54,6%) e teve um padrão semelhante ao da cefaleia de tipo tensional (53,6%). A cefaleia atribuída ao AVCi esteve significativamente associada à cefaleia de tipo tensional prévia, e à migrânea com e sem aura prévias (regressão logística).

Conclusão A cefaleia atribuída ao AVCi é frequente, tem padrão mais habitual semelhante ao da cefaleia de tipo tensional, e está associada aos antecedentes de cefaleia de tipo tensional e migrânea.

Author's Contributions

FAAO: conception of the work, data collection, data analysis and interpretation, and drafting of the article; MGDF: data collection and data analysis; PASRF: conception of the work, data analysis and interpretation, drafting of the article, and revision of the article.

Publication History

Received: 10 April 2022

Accepted: 26 October 2022

Article published online:
14 April 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

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