Persistent headache after stroke: not rare and often overlooked

Persistent headache attributable to ischaemic stroke is not rare and frequently leads to medication overuse. It has a considerable impact on quality of life and should be monitored during the follow-up of stroke patients. These were the main conclusions drawn from a Russian study of this often neglected problem.

Persistent headache after ischaemic stroke is increasingly acknowledged and was added to the 3rd edition of the International Classification of Headache Disorders (ICHD-3) in 2018 [1]. Prof. Elena Lebedeva (Ural State Medical University, Russia) and colleagues set up a study with 550 patients who had experienced a first-ever ischaemic stroke [1,2]. The study aimed to determine the incidence of headache attributed to stroke; describe its characteristics and acute treatment; evaluate risk factors; and analyse the prevalence of medication overuse headache (MOH).

Of 550 participants, 82 (15%) had headache at the onset of first-ever ischaemic stroke. This was a new type of headache in 8.4%, headache with altered characteristics in 5.4%, and a usual headache without any changes in 1.2%. By contrast, none of the participants in the control group experienced a new type of headache, and only 2 had a headache with altered characteristics (P<0.009). These 2 types of headaches are causally related to ischaemic stroke, Prof. Lebedeva inferred. Of controls, 9 (4.6%) had a usual headache.

Of this cohort, 529 patients were followed up for at least 3 months after stroke. In this group, 61 (11.5%) had a headache after stroke; 34 (6.4%) experienced a new type of headache, 21 (4.0%) had a headache with altered characteristics, and 6 (1.2%) had an unchanged headache. The 55 patients with persistent headache attributable to stroke had less severe accompanying symptoms and a slowly decreasing frequency; one-third developed MOH. In patients with a new type of headache, migraine-like headache was the most prevalent (n=20); in patients with a headache with altered characteristics, a tension-type headache was the most prevalent (n=16). The most important factors associated with persistent headaches were a score of <8 points on the NIHSS (90.9%, P=0.007), stroke of undetermined aetiology (50.9%; P=0.003), and lack of sleep (29.1%; P=0.009).

 

Prof. Lebdeva summarised the following take-home messages:

• • Take your time to take the history of headache at stroke onset and for headache that persists for >3 months after stroke.
  • Remember to diagnose and treat persistent headache after stroke and prevent MOH in these patients.

 

1. 1. Lebedeva ER. Persistent headache after first-ever ischemic stroke: clinical characteristics and factors associated with their development. Abstract A44, EHC 2022, 07-10 December, Vienna, Austria.
   2. Lebedeva ER, et al. J Headache Pain. 2022;23(1):103.

 

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Posted on 5 January, 20235 January, 2023