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Updated: Sep 4, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
De novo headache in ischemic stroke patients treated with thrombectomy: a prospective study
Daniel Gallo1, Leire Manrique1, Marcos Polanco1
1Services of Neurology and Radiology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain.
Insights
Headache affects over a quarter of ischemic stroke patients after endovascular thrombectomy. A history of primary headaches increases the likelihood of experiencing this post-procedure symptom.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Headache is a recognized complication of intracranial endovascular procedures.
- Thrombectomy is a key treatment for ischemic stroke.
Purpose of the Study:
- To investigate the frequency and characteristics of headaches following mechanical thrombectomy in ischemic stroke patients.
- To identify factors associated with post-thrombectomy headache.
Main Methods:
- Prospective study involving 117 ischemic stroke patients undergoing thrombectomy.
- Clinical features of headache were assessed using a dedicated questionnaire.
- Data collected included patient demographics, procedure details, and headache characteristics.
Main Results:
- Headache occurred in 26.5% of patients post-thrombectomy.
- A history of primary headaches was significantly associated with post-thrombectomy headache (p=0.004).
- Headache was typically moderate, ipsilateral to occlusion, and lasted less than 48 hours.
Conclusions:
- Nearly one-third of ischemic stroke patients experience headache within 24 hours of endovascular thrombectomy.
- Pre-existing headache history is a key predictor, independent of procedure complexity.
- This finding highlights the importance of considering pre-existing headache in managing post-thrombectomy patients.
Background And Aim:
Headache attributed to intracranial endovascular procedures is described in the ICHD-3. Our aim was to study the frequency and characteristics of headache specifically related to thrombectomy in patients with ischemic stroke.
Methods:
Prospective evaluation of clinical features of headache after thrombectomy using an ad hoc questionnaire.
Results:
One hundred seventeen patients were included (52.1% females). Most had an anterior circulation artery occlusion (91.5%). 93 (79.5%) received general anaesthesia. 111 (94.9%) required stent retriever, 21 (24.4%) angioplasty and 19 (16.2%) aspiration thrombectomy. 31 (26.5%; 95% CI 18.8-35.5%) had headache related to thrombectomy, and it was associated with a history of primary headache (p = 0.004). No differences about sex, initial NIHSS score, or the type or complexity of the procedure were observed. Headache was usually moderate and oppressive, ipsilateral to the artery occlusion and usually lasted less than 48 hours.
Conclusions:
Almost one-third of patients with ischemic stroke who undergo endovascular thrombectomy experience headache in the first 24 hours, occurring more frequently in patients who had a previous history of headaches regardless of the procedure complexity.
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