Download PDF
CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(09): 893-899
DOI: 10.1055/s-0042-1755269
Original Article

Characterization of persistent headache attributed to past stroke

Caracterização da cefaleia persistente atribuída a acidente vascular cerebral prévio
André Rêgo 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Rita Pinheiro 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Sofia Delgado 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Francisco Bernardo 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Elsa Parreira 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Persistent headache attributed to past stroke (PHAPS) is a controversial entity, recently included in the third edition of the International Classification of Headache Disorders (ICHD-3) despite being described only in retrospective studies.

Objective To determine the frequency and characteristics of PHAPS in patients admitted with acute stroke.

Methods We selected all patients with headache associated with acute stroke (HAAS) from a prospective, single-center registry of patients with acute stroke admitted to a Neurology ward between November 2018 and December 2019. We analyzed demographic, clinical, and neuroimaging data. We assessed the follow-up with a phone call questionnaire at 6 to 12 months.

Results Among 121 patients with acute stroke, only 29 (24.0%) had HAAS. From these, 6 (5.0%) were lost to follow-up. In total, 23 (20.0%) patients answered the 6- to 12-month follow-up questionnaire and were included in this study. The median age of the sample was 53 years (interquartile range [IQR]: 38–78 years), and there was no sex predominance. Of the 10 patients (8,3%) that had persistent headache, 8 (6.6%) suffered from previous chronic headaches; however, they all mentioned a different kind of headache, and 1 (0,8%) probably had headache secondary to medication.

Conclusions In the present study, only 10 out of 121 stroke patients (8.3%) referred persistent headache at the 6- to 12-month follow-up, but the majority already suffered from previous chronic headache, which raises the question that the actual prevalence of PHAPS may be lower than previously reported.

Resumo

Antecedentes A cefaleia persistente atribuída a acidente vascular cerebral (AVC) prévio é uma entidade controversa, recentemente incluída na terceira edição da Classificação Internacional de Transtornos da Cefaleia (International Classification of Headache Disorders, ICHD-3), apesar de descrita apenas em estudos restrospectivos.

Objetivo Determinar a frequência e as características do acidente vascular cerebral prèvio em doentes admitidos com AVC agudo.

Métodos Selecionamos todos os doentes com cefaleia associada a AVC agudo de um registro unicêntrico e prospectivo de doentes admitidos no serviço de Neurologia entre novembro de 2018 e dezembro de 2019. Analisamos dados demográficos, clínicos e imagiológicos. Reavaliamos aos 6 a 12 meses por questionário telefónico.

Resultados Entre os 121 doentes admitidos com AVC agudo, apenas 29 (24,0%) tinham cefaleia associada a AVC agudo. Destes, 6 (5,0%) perderam-se no seguimento. Ao todo, 23 (20,0%) responderam ao questionário e foram incluídos. A idade mediana foi de 53 anos (intervalo interquartílico [IIQ]: 38–78 anos), e não houve predominância de gênero. Dos 10 doentes (8,3%) que apresentam cefaleia persistente, 8 (6,6%) tinham histórico de cefaleia; no entanto todos mencionaram um tipo diferente de cefaleia, e 1 (0,8%) provavelmente tinha cefaleia secundária a medicação.

Conclusões Neste estudo, apenas 10 em 121 doentes (8,3%) mencionaram cefaleia persistente aos 6 a 12 meses de seguimento, mas a maioria sofria de cefaleia prévia, pelo que a real prevalência de acidente vascular cerebral prèvio pode ser inferior à descrita nos estudos realizados até a data.

Keywords

Vascular Headaches - Headache Disorders, Secondary

Palavras-chave

Cefaleias Vasculares - Transtornos da Cefaleia Secundários

Authors' Contributions

AR: writing the first draft of the manuscript; RP, SD: data collection; AR, FB: statistical analysis; and EP: supervision.




Publication History

Received: 07 July 2021

Accepted: 31 October 2021

Article published online:
09 November 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Stovner LJ, Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain 2010; 11 (04) 289-299
    CrossrefPubMedGoogle Scholar
  • 2 Rodrigues AP, Silva S, Batista I. et al. Médicos-Sentinela: o que se fez em 2012. Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge; 2014
    Google Scholar
  • 3 Oliveira FAA, Sampaio Rocha-Filho PA. Headaches Attributed to Ischemic Stroke and Transient Ischemic Attack. Headache 2019; 59 (03) 469-476
    CrossrefPubMedGoogle Scholar
  • 4 Dohmen C, Sakowitz OW, Fabricius M. et al; Co-Operative Study of Brain Injury Depolarisations (COSBID). Spreading depolarizations occur in human ischemic stroke with high incidence. Ann Neurol 2008; 63 (06) 720-728
    CrossrefPubMedGoogle Scholar
  • 5 Leira R, Dávalos A, Aneiros A, Serena J, Pumar JM, Castillo J. Headache as a surrogate marker of the molecular mechanisms implicated in progressing stroke. Cephalalgia 2002; 22 (04) 303-308
    CrossrefPubMedGoogle Scholar
  • 6 Naess H, Lunde L, Brogger J, Waje-Andreassen U. Post-stroke pain on long-term follow-up: the Bergen stroke study. J Neurol 2010; 257 (09) 1446-1452
    CrossrefPubMedGoogle Scholar
  • 7 Ferro JM, Melo TP, Guerreiro M. Headaches in intracerebral hemorrhage survivors. Neurology 1998; 50 (01) 203-207
    CrossrefPubMedGoogle Scholar
  • 8 Verdelho A, Ferro JM, Melo T, Canhão P, Falcão F. Headache in acute stroke. A prospective study in the first 8 days. Cephalalgia 2008; 28 (04) 346-354
    CrossrefPubMedGoogle Scholar
  • 9 Widar M, Samuelsson L, Karlsson-Tivenius S, Ahlström G. Long-term pain conditions after a stroke. J Rehabil Med 2002; 34 (04) 165-170
    CrossrefPubMedGoogle Scholar
  • 10 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38 (01) 1-211
    PubMedGoogle Scholar
  • 11 Hansen AP, Marcussen NS, Klit H, Kasch H, Jensen TS, Finnerup NB. Development of persistent headache following stroke: a 3-year follow-up. Cephalalgia 2015; 35 (05) 399-409
    CrossrefPubMedGoogle Scholar
  • 12 Lai J, Harrison RA, Plecash A, Field TS. A Narrative review of persistent post-stroke headache – a new entry in the International Classification of Headache Disorders, 3rd edition. Headache 2018; 58 (09) 1442-1453
    CrossrefPubMedGoogle Scholar
  • 13 Klit H, Finnerup NB, Overvad K, Andersen G, Jensen TS. Pain following stroke: a population-based follow-up study. PLoS One 2011; 6 (11) e27607
    Google Scholar
  • 14 Jönsson AC, Lindgren I, Hallström B, Norrving B, Lindgren A. Prevalence and intensity of pain after stroke: a population based study focusing on patients' perspectives. J Neurol Neurosurg Psychiatry 2006; 77 (05) 590-595
    CrossrefPubMedGoogle Scholar
  • 15 Tombari D, Loubinoux I, Pariente J. et al. A longitudinal fMRI study: in recovering and then in clinically stable sub-cortical stroke patients. Neuroimage 2004; 23 (03) 827-839
    CrossrefPubMedGoogle Scholar
  • 16 McNeal DW, Darling WG, Ge J. et al. Selective long-term reorganization of the corticospinal projection from the supplementary motor cortex following recovery from lateral motor cortex injury. J Comp Neurol 2010; 518 (05) 586-621
    CrossrefPubMedGoogle Scholar
  • 17 Hodkinson DJ, Wilcox SL, Veggeberg R. et al. Increased amplitude of thalamocortical low-frequency oscillations in patients with migraine. J Neurosci 2016; 36 (30) 8026-8036
    CrossrefPubMedGoogle Scholar
  • 18 Coppola G, Di Renzo A, Tinelli E. et al. Thalamo-cortical network activity during spontaneous migraine attacks. Neurology 2016; 87 (20) 2154-2160
    CrossrefPubMedGoogle Scholar
  • 19 Chong CD, Gaw N, Fu Y, Li J, Wu T, Schwedt TJ. Migraine classification using magnetic resonance imaging resting-state functional connectivity data. Cephalalgia 2017; 37 (09) 828-844
    CrossrefPubMedGoogle Scholar
  • 20 Hougaard A, Amin FM, Larsson HB, Rostrup E, Ashina M. Increased intrinsic brain connectivity between pons and somatosensory cortex during attacks of migraine with aura. Hum Brain Mapp 2017; 38 (05) 2635-2642
    CrossrefPubMedGoogle Scholar
  • 21 Amin FM, Hougaard A, Magon S. et al. Change in brain network connectivity during PACAP38-induced migraine attacks: A resting-state functional MRI study. Neurology 2016; 86 (02) 180-187
    CrossrefPubMedGoogle Scholar
  • 22 Tedeschi G, Russo A, Conte F. et al. Increased interictal visual network connectivity in patients with migraine with aura. Cephalalgia 2016; 36 (02) 139-147
    CrossrefPubMedGoogle Scholar
  • 23 Niddam DM, Lai KL, Fuh JL, Chuang CY, Chen WT, Wang SJ. Reduced functional connectivity between salience and visual networks in migraine with aura. Cephalalgia 2016; 36 (01) 53-66
    CrossrefPubMedGoogle Scholar
  • 24 Chen Z, Chen X, Liu M, Dong Z, Ma L, Yu S. Altered functional connectivity of amygdala underlying the neuromechanism of migraine pathogenesis. J Headache Pain 2017; 18 (01) 7
    CrossrefPubMedGoogle Scholar
  • 25 Schmidt-Wilcke T, Leinisch E, Straube A. et al. Gray matter decrease in patients with chronic tension type headache. Neurology 2005; 65 (09) 1483-1486
    CrossrefPubMedGoogle Scholar
  • 26 Evans RW, Mitsias PD. Headache at onset of acute cerebral ischemia. Headache 2009; 49 (06) 902-908
    CrossrefPubMedGoogle Scholar
  • 27 Koudstaal PJ, van Gijn J, Kappelle LJ. Dutch TIA Study Group. Headache in transient or permanent cerebral ischemia. Stroke 1991; 22 (06) 754-759
    CrossrefPubMedGoogle Scholar
  • 28 Portenoy RK, Abissi CJ, Lipton RB. et al. Headache in cerebrovascular disease. Stroke 1984; 15 (06) 1009-1012
    CrossrefPubMedGoogle Scholar
  • 29 Ahmadi Aghangar A, Bazoyar B, Mortazavi R, Jalali M. Prevalence of headache at the initial stage of stroke and its relation with site of vascular involvement: A clinical study. Caspian J Intern Med 2015; 6 (03) 156-160
    PubMedGoogle Scholar
  • 30 Pollak L, Shlomo N, Korn Lubetzki I. National Acute Stroke Israeli Survey Group. Headache in stroke according to National Acute Stroke Israeli Survey. Acta Neurol Scand 2017; 135 (04) 469-475
    CrossrefPubMedGoogle Scholar
  • 31 Arboix A, Massons J, Oliveres M, Arribas MP, Titus F. Headache in acute cerebrovascular disease: a prospective clinical study in 240 patients. Cephalalgia 1994; 14 (01) 37-40
    CrossrefPubMedGoogle Scholar
  • 32 Arboix A, García-Trallero O, García-Eroles L, Massons J, Comes E, Targa C. Stroke-related headache: a clinical study in lacunar infarction. Headache 2005; 45 (10) 1345-1352
    CrossrefPubMedGoogle Scholar
  • 33 Mitsias PD, Ramadan NM, Levine SR, Schultz L, Welch KM. Factors determining headache at onset of acute ischemic stroke. Cephalalgia 2006; 26 (02) 150-157
    CrossrefPubMedGoogle Scholar
  • 34 Ferro JM, Melo TP, Oliveira V. et al. A multivariate study of headache associated with ischemic stroke. Headache 1995; 35 (06) 315-319
    CrossrefPubMedGoogle Scholar
  • 35 Tentschert S, Wimmer R, Greisenegger S, Lang W, Lalouschek W. Headache at stroke onset in 2196 patients with ischemic stroke or transient ischemic attack. Stroke 2005; 36 (02) e1-e3
    CrossrefPubMedGoogle Scholar
  • 36 Kumral E, Bogousslavsky J, Van Melle G, Regli F, Pierre P. Headache at stroke onset: the Lausanne Stroke Registry. J Neurol Neurosurg Psychiatry 1995; 58 (04) 490-492
    CrossrefPubMedGoogle Scholar
  • 37 Hansen AP, Marcussen NS, Klit H, Andersen G, Finnerup NB, Jensen TS. Pain following stroke: a prospective study. Eur J Pain 2012; 16 (08) 1128-1136
    CrossrefPubMedGoogle Scholar
  • 38 Arboix A, Grau-Olivares M, García-Eroles L, Massons J, Comes E, Targa C. Clinical implications of headache in lacunar stroke: relevance of site of infarct. Headache 2006; 46 (07) 1172-1180
    CrossrefPubMedGoogle Scholar
  • 39 Vestergaard K, Andersen G, Nielsen MI, Jensen TS. Headache in stroke. Stroke 1993; 24 (11) 1621-1624
    CrossrefPubMedGoogle Scholar
  • 40 Salgado AV, Ferro JM. Headache in lacunar stroke. Cephalalgia 1995; 15 (05) 410-413
    CrossrefPubMedGoogle Scholar