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Published on: June 18, 2021
Relation of post-stroke headachto cerebrovascular pathology and hemodynamics
Elsayed Abed1, Nabil Hussein Mohammed1, Ahmed Hassan Elsheshiny1
1Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Insights
Post-stroke headache is common, especially with prior headaches or posterior circulation strokes. Intracranial vascular changes like stenosis and collateral flow significantly predict headache development after ischemic stroke.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Headache following ischemic stroke is frequently overlooked and undertreated.
- Understanding the link between post-stroke headache and cerebrovascular pathology is crucial for effective management.
Purpose of the Study:
- To investigate the relationship between post-stroke headache and cerebrovascular conditions.
- To identify hemodynamic changes associated with post-stroke headache using high-resolution duplex ultrasound.
Main Methods:
- A case-control study involving 239 patients with acute ischemic stroke.
- Patients were divided into two groups: those with post-stroke headache (cases) and those without (controls).
- High-resolution duplex ultrasound assessed extra-cranial and intra-cranial cerebrovascular systems; clinical and radiological data were collected.
Main Results:
- Post-stroke headache occurred in 58% of patients with posterior circulation infarction and within 7 days in 61.6% of cases.
- Pre-stroke headache (OR=28.187) and intracranial vascular stenosis/collateral opening (OR=25.071) were strong predictors.
- Headaches were typically moderate-intensity, resembling tension-type headaches.
Conclusions:
- Post-stroke headache is a common occurrence, particularly in patients with a history of pre-stroke headache, prior stroke, posterior circulation infarction, or large artery disease.
- Intracranial cerebrovascular pathologies, including stenosis and collateral channel formation, are implicated in the development of post-stroke headaches.
- High-resolution duplex ultrasound is valuable for detecting these vascular changes and understanding their association with post-stroke headache.
Abstract:
Despite high prevalence of cerebrovascular stroke, headache attributed to ischemic strokes is often undertreated and overlooked. The aim is to detect the relation of a post-stroke headache to cerebrovascular pathology and changes in hemodynamics through a high-resolution duplex ultrasound examination. The present study was a case-control study conducted among 239 patients, who presented with an acute ischemic stroke. Patients were sub-divided into two groups: group I included patients with headache attributed to ischemic stroke (cases) and group II included headache-free stroke patients (controls). History consisted of headache characteristics and risk factors. Clinical and radiological examination were preformed to detect the type of stroke. Ultrasound duplex examination of extra-cranial and intra-cranial cerebrovascular system was carried for both groups. Group I included 112 patients (mean age, 57.66 ±6.59 years), and group II included 127 patients (mean age 57.73 ±7.89 years). Post-stroke headache was more frequent in patients with posterior circulation infarction (58%). Post-stroke headache was reported within 7 days post-stroke in 61.6% of patients. Pre-stroke headache was an independent predictor for post-stroke headache occurrence (OR = 28.187, 95% CI: 6.612-120.158%, p < 0.001). Collateral opening and various degrees of intra-cranial vascular stenosis were strong predictors of headache occurrence (OR = 25.071, 95% CI: 6.498-96.722%, p < 0.001). In conclusion, post-stroke headache is a common phenomenon, especially in patients with pre-stroke headache, history of old stroke, posterior circulation infarction, and large artery disease. This headache was of moderate-intensity with clinical characteristics of tension-type. Intra-cranial cerebrovascular pathological changes including opening of collateral channels and variable degrees of stenosis of cerebrovascular systems were implicated in the production of that headache.
