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Remote poststroke headache in children: Characteristics and association with stroke recurrence
Ana B Chelse1, Jonathan E Kurz1, Kathleen M Gorman1
1Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
Insights
New-onset headache is common in children after ischemic stroke, affecting 36% of survivors. This headache may increase the risk of recurrent stroke in pediatric patients.
Area of Science:
- Pediatric Neurology
- Stroke Medicine
- Neuroepidemiology
Background:
- New-onset headache is a frequent complication in adult stroke survivors, but data in children are scarce.
- Understanding post-stroke headache in pediatric populations is crucial for comprehensive care.
Purpose of the Study:
- To determine the prevalence of new-onset headache following pediatric ischemic stroke.
- To characterize patients with post-stroke headache and explore its association with stroke recurrence.
Main Methods:
- A retrospective study of children (30 days to 18 years) diagnosed with arterial ischemic stroke (AIS) between 2008 and 2016.
- Post-stroke headache, defined as headache occurring >30 days after stroke, was identified via electronic medical record review.
Main Results:
- Of 115 pediatric AIS patients, 41 (36%) developed post-stroke headache, with a median onset of 6 months.
- Older age at stroke and arteriopathy were significantly associated with post-stroke headache.
- Post-stroke headache was linked to an increased risk of stroke recurrence (p=0.049).
Conclusions:
- Remote post-stroke headache is a common issue in pediatric stroke survivors, especially older children.
- Headaches in these patients often lead to significant healthcare utilization, including emergency visits and hospital admissions.
- A potential association between post-stroke headache and subsequent stroke recurrence warrants further investigation.
Background:
New-onset headache after stroke is common among adult stroke survivors. However, pediatric data are limited. The primary aim of this study was to investigate the prevalence of new-headache after pediatric ischemic stroke. Secondary outcomes were to describe the characteristics of patients experiencing poststroke headache and the association between poststroke headache and stroke recurrence.
Methods:
We conducted a single-center retrospective study on children aged 30 days to 18 years with a confirmed radiographic diagnosis of arterial ischemic stroke (AIS) from January 1, 2008, to December 31, 2016. Patients were identified from an internal database, with additional data abstracted from the electronic medical record. Poststroke headache (occurring >30 days after stroke) was identified through electronic searches of the medical record and confirmed by chart review.
Results:
Of 115 patients with confirmed AIS, 41 (36%) experienced poststroke headache, with headache developing a median of 6 months after stroke. Fifty-one percent of patients with poststroke headache presented to the emergency department for headache evaluation; 81% of the patients had an inpatient admission for headache. Older age at stroke (odds ratio [OR] 21.5; p = 0.0001) and arteriopathy (OR 8.65; p = 0.0029) were associated with development of poststroke headache in a multivariable analysis. Seventeen patients (15%) had a recurrent stroke during the study period. Poststroke headache was associated with greater risk for stroke recurrence (p = 0.049).
Conclusions:
Remote poststroke headache is a common morbidity among pediatric stroke survivors, particularly in older children. Headaches may increase health care utilization, including neuroimaging and hospital admissions. We identified a possible association between poststroke headache and stroke recurrence.
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