HEADACHE IN ACUTE CEREBROVASCULAR-DISEASE - A PROSPECTIVE CLINICAL-STUDY IN 240 PATIENTS

To evaluate the clinical features of headache in stroke, a prospective study was carried out in 240 consecutive patients with acute stroke w ho had intact expressive function. Headache occurred in 38%: 32% of 19 5 patients with ischemic stroke and 64.5% of 45 patients with hemorrha gic stroke (p < 0.0001). Headache patients were younger (mean age 62 /- 15 vs 67 +/- 11.5 years) than non-headache patients (p < 0.01). A h istory of previous vascular or tension-type headache was found in 40.5 % of the headache group, but in only 23.5% of the non-headache group ( p < 0.01). In ischemic stroke, headache was observed in 41% of thrombo tic infarcts, in 39% of cardioembolic infarcts, in 23% of lacunar infa rcts and in 26% of TIA. Headache was significantly more common in thro mbotic than lacunar infarcts (p < 0.05). In hemorrhagic stroke, headac he was observed in all subarachnoid hemorrhages and in 58% of intrapar enchymal hemorrhages. In ischemic stroke, the mean duration of the hea dache was 25 +/- 28 h and in hemorrhagic stroke 64.5 +/- 36.5 h (p < 0 .00001). In ischemic stroke the headache was focal in 74% and mild or moderate in intensity in 74%. In hemorrhagic stroke, it was diffuse in 52% and the pain intensity was incapacitating in 70%. Headache was mo re common in vertebrobasilar stroke (59%), in comparison with carotid stroke (26%) or stroke of unclear vascular topography (33%) (p < 0.000 01). Fifty-six and a half percent of patients with cortical stroke had headaches, as opposed to only 26.5% of patients with subcortical stro ke (p < 0.005). Ten percent of the patients presented with sentinel he adache.