Headache in intracerebral hematomas

We sought to describe the frequency and location of headache in intracerebral hematoma (ICH) and to analyze its clinical and CT predictors by means of multivariate analysis.

Headache is more common in intracerebral hemorrhage than in ischemic stroke, and its frequency varies with hematoma location, but the pathophysiologic mechanisms of headache associated with ICH are not fully known.

We examined a cohort of 289 patients with ICH during a 14-month period in a university hospital. Clinical, including the presence and location of headache, and CT features were collected by two neurologists.

One hundred and sixty-five (57%) patients with ICH had a headache at the onset of their stroke. Headache was more common in cerebellar and lobar hemorrhages than in deep ones (thalamic, caudate, capsuloputaminal, brainstem). Headache was also more common in women, patients younger than 70 years, those who vomited, and those with meningeal signs, a Glasgow Coma Scale score < 10, a hematoma volume > 10 ml or CT evidence of intraventricular or subarachnoid bleeding, moderate to severe hydrocephalus, or transtentorial herniation or midline shift. In multiple logistic regression analysis, only meningeal signs (odds ratio [OR] = 2.3), cerebellar or lobar location (OR = 2.1), transtentorial herniation (OR = 1.8), and female gender (OR = 1.6) were significant predictors of headache at the onset of ICH.

Hematoma location, meningeal signs, and gender are more predictive of headache than hematoma volume, suggesting that headache is more often related to the activation of an anatomically distributed system in susceptible individuals and to subarachnoid bleeding than to intracranial hypertension.