Related Experiment Videos
Headaches in intracerebral hemorrhage survivors
J M Ferro1, T P Melo, M Guerreiro
1Department of Neurology, Faculdade de Medicina de Lisboa, Hospital de Santa Maria, Lisbon, Portugal.
Insights
Intracerebral hemorrhage (ICH) survivors often experience new or ongoing headaches. Chronic post-stroke headaches are typically tension-type and linked to depression, while some headaches may remit after ICH.
Area of Science:
- Neurology
- Neuroscience
- Stroke Medicine
Background:
- Limited data exists on headache characteristics in acute cerebrovascular disease survivors.
- Intracerebral hemorrhage (ICH) survivors represent a critical population for studying post-stroke neurological sequelae.
- Headache is a common symptom, but its trajectory after ICH requires further investigation.
Purpose of the Study:
- To characterize the lifetime history of headaches in intracerebral hemorrhage (ICH) survivors.
- To analyze headache patterns before and after ICH, including new-onset and remitted headaches.
- To explore associations between post-ICH headaches, disability, depression, and intracranial lesions.
Main Methods:
- A cohort of 90 ICH survivors was followed for 2 years.
- Neurologic interviews and headache questionnaires were used to gather data.
- Headaches were classified using International Headache Society criteria; disability and depression were assessed using the Rankin and CERAD scales, respectively.
Main Results:
- 43% of survivors had ongoing headaches, 11% developed new-onset headaches, and 19% experienced headache remission post-ICH.
- New-onset headaches were primarily tension-type, significantly associated with depression but not new intracranial lesions.
- Headaches that remitted were linked to alcohol consumption and migraines; chronic headaches were associated with depression.
Conclusions:
- Headache patterns significantly change after intracerebral hemorrhage (ICH).
- Chronic post-ICH headaches are frequently tension-type and comorbid with depression.
- Headache remission may be linked to the elimination of triggers like alcohol or neurobiological changes post-ICH.
Abstract:
Few data exist on headache in survivors of acute cerebrovascular disease. During the second year of follow-up of a cohort of intracerebral hemorrhages (ICH), the lifetime history of headache before stroke and 2 years after stroke was characterized through a neurologic interview and a headache questionnaire. Headaches were classified following the International Headache Society classification categories. Disability (Rankin scale) and depression (CERAD depression scale) were also evaluated. Ninety survivors were interviewed. Comparing the distribution of pre- and post-ICH headaches, 24 subjects (27%) never had headaches, 39 subjects (43%) had ongoing headaches, 10 subjects (11%) complained of headaches only after ICH, and 17 subjects' (19%) headaches remitted after ICH. There was usually a delay of weeks or months between ICH and the first headache episode. Poststroke headaches were in general less severe and frequent than prestroke headaches. New-onset headaches after ICH were mainly of the tension type and were significantly associated with depression but not with new intracranial lesions. Headaches in remission after ICH were related to acute alcohol consumption and migraines. Chronic post-ICH headaches are usually tension type and occur in association with depression. Remission of headaches after ICH is related to removal of headache precipitants (alcohol) and possibly to structural or functional changes of the trigeminovascular system secondary to intracranial bleeding.