HEADACHE IN STROKE

Background and Purpose: The etiology of headache in stroke is not know n, and its relation to migraine and tension-type headache is unclear. The aim of our study was to investigate and classify headache appearin g in stroke patients prospectively, using the new headache classificat ion as determined by the Headache Classification Committee of the Inte rnational Headache Society (1988). Methods: Two hundred eighty consecu tively admitted patients aged younger than 81 years with acute stroke were examined and questioned about headache and prior headache complai nts; 238 (85%) were able to communicate. Results: Sixty-five (27%) of the 238 patients experienced headache from 3 days before to 3 days aft er stroke. Headache occurred in 50% of patients with intracerebral hem orrhage, in 26% with infarction, and in 15% of patients with lacunar i nfarction. Headache was more common when stroke occurred in posterior circulation than anterior circulation (P<.02). Fifty-six patients were able to give further information about headache characteristics. The headache in thromboembolic stroke was classified as tension-type heada che (25 patients), migraine-like headache (14 patients), and other hea dache (12 patients). Migraine was more frequent in vertebrobasilar str oke. Headache was lateralized in 33% of cases. In patients with unilat eral headache and unilateral stroke lesion, the headache was ipsilater al in 14 of 17 cases. In infarction, severity of headache showed no re lation to lesion size or lesion localization. Patients with previous t ension-type headache and migraine experienced reactivation of known he adache equally often. Conclusions: (1) Headache occurs in one fourth o f patients with acute stroke. (2) Unilateral headache is usually ipsil ateral to stroke lesion. (3) Headache severity is not related to size of ischemic stroke lesion.