Lacunar stroke associated headache is not related to intracranial large vessel disease

It was recently suggested that lacunar strokes presenting with headache may be due to large intracranial artery disease. From the stroke database of the Neurology department, Hospital Sta Maria, we retrieved all lacunar strokes who had investigations of the intracranial circulation. Forty seven of the 208 lacunar strokes registered had either angiography (5 cases) or transcranial doppler (42 cases). Twelve subjects noticed headache during stroke onset, but all had normal investigations of the intracranial circulation. In five patients transcranial Doppler showed ipsilesional increased peak systolic velocities and another subject had a middle cerebral artery branch occlusion. None of them reported headache. Headache associated with lacunar strokes is not related to intracranial artery disease.