HEADACHES IN INTRACEREBRAL HEMORRHAGE SURVIVORS

Few data exist on headache in survivors of acute cerebrovascular disea se. During the second year of follow-up of a cohort of intracerebral h emorrhages (ICH), the lifetime history of headache before stroke and 2 years after stroke was characterized through a neurologic interview a nd a headache questionnaire. Headaches were classified following the I nternational Headache Society classification categories. Disability (R ankin scale) and depression (CERAD depression scale) were also evaluat ed. Ninety survivors were interviewed. Comparing the distribution of p re-and post-ICH headaches, 24 subjects (27%) never had headaches, 39 s ubjects (43%) had ongoing headaches, 10 subjects (11%) complained of h eadaches only after ICH, and 17 subjects' (19%) headaches remitted aft er ICH. There was usually a delay of weeks or months between ICH and t he first headache episode. Poststroke headaches were in general less s evere 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 r emission after ICH were related to acute alcohol consumption and migra ines. Chronic post-ICH headaches are usually tension type and occur in association with depression. Remission of headaches after ICH is rela ted to removal,of headache precipitants (alcohol) and possibly to; str uctural or functional changes of the trigeminovascular system secondar y to intracranial bleeding.