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Headache and Acute Stroke

  • Secondary Headache (K Henry and M Robbins, Section Editors)
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Abstract

Disorders associated with prominent headaches, such as migraine with aura and cerebral arterial and venous diseases, increase the risk of ischemic and hemorrhagic stroke. Central nervous system vasculitis, posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, and cerebral venous thrombosis are all disorders associated with severe or persistent headache in which the risk for ischemic and hemorrhagic stroke is increased. Hemorrhagic strokes, more frequently than ischemic strokes, present with distinct headaches, usually accompanied by focal neurological symptoms. Pregnancy, and especially the postpartum period, is a time of overlap between new-onset headache and stroke risk.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. (IHS) HCCotIHS. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  2. Tentschert S, Greisenegger S, Wimmer R, Lang W, Lalouschek W. Association of parental history of stroke with clinical parameters in patients with ischemic stroke or transient ischemic attack. Stroke. 2003;34:2114–9.

    Article  CAS  PubMed  Google Scholar 

  3. Goddeau RP, Alhazzani A. Headache in stroke: a review. Headache. 2013;53:1019–22. The most recently published review of headache in cerebrovascular disease, including ischemic and hemorrhagic stroke, cerebral venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, and CADASIL. The emphasis is on differentiating clinical characteristics of headache in stroke.

    Article  PubMed  Google Scholar 

  4. Kurth T, Chabriat H, Bousser MG. Migraine and stroke: a complex association with clinical implications. Lancet Neurol. 2012;11:92–100.

    Article  PubMed  Google Scholar 

  5. Nesher G. The diagnosis and classification of giant cell arteritis. J Autoimmun. 2014;48–49:73–5.

    Article  PubMed  Google Scholar 

  6. Alhazzani A, Goddeau RP. Migraine and stroke: a continuum of association in adults. Headache. 2013;53:1023–7.

    Article  PubMed  Google Scholar 

  7. Tietjen GE. The risk of stroke in patients with migraine and implications for migraine management. CNS Drugs. 2005;19:683–92.

    Article  PubMed  Google Scholar 

  8. Li H, Yu Y. Association between ischemic stroke and migraine in elderly Chinese: a case-control study. BMC Geriatr. 2013;13:126.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA. 2006;296:283–91.

    Article  CAS  PubMed  Google Scholar 

  10. Kurth T, Gaziano JM, Cook NR, Bubes V, Logroscino G, Diener HC, et al. Migraine and risk of cardiovascular disease in men. Arch Intern Med. 2007;167:795–801.

    Article  PubMed  Google Scholar 

  11. Kurth T, Tzourio C. Bloody migraine? Stroke. 2013;44:2987–8.

    Article  PubMed  Google Scholar 

  12. Sacco S, Ornello R, Ripa P, Pistoia F, Carolei A. Migraine and hemorrhagic stroke: a meta-analysis. Stroke. 2013;44:3032–8.

    Article  PubMed  Google Scholar 

  13. Kuo CY, Yen MF, Chen LS, Fann CY, Chiu YH, Chen HH, et al. Increased risk of hemorrhagic stroke in patients with migraine: a population-based cohort study. PLoS One. 2013;8:e55253.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Ross OA, Soto-Ortolaza AI, Heckman MG, Verbeeck C, Serie DJ, Rayaprolu S, et al. NOTCH3 variants and risk of ischemic stroke. PLoS One. 2013;8:e75035.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Rinnoci V, Nannucci S, Valenti R, Donnini I, Bianchi S, Pescini F, et al. Cerebral hemorrhages in CADASIL: report of four cases and a brief review. J Neurol Sci. 2013;330:45–51.

    Article  PubMed  Google Scholar 

  16. Gunda B, Mine M, Kovács T, Hornyák C, Bereczki D, Várallyay G, et al. COL4A2 mutation causing adult onset recurrent intracerebral hemorrhage and leukoencephalopathy. J Neurol. 2014;261:500–3.

    Article  PubMed  Google Scholar 

  17. Verdelho A, Ferro JM, Melo T, Canhão P, Falcão F. Headache in acute stroke. A prospective study in the first 8 days. Cephalalgia. 2008;28:346–54.

    Article  CAS  PubMed  Google Scholar 

  18. Ferro JM, Melo TP, Oliveira V, Salgado AV, Crespo M, Canhão P, et al. A multivariate study of headache associated with ischemic stroke. Headache. 1995;35:315–9.

    Article  CAS  PubMed  Google Scholar 

  19. Kumral E, Bogousslavsky J, Van Melle G, Regli F, Pierre P. Headache at stroke onset: the Lausanne Stroke Registry. J Neurol Neurosurg Psychiatry. 1995;58:490–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Koudstaal PJ, van Gijn J, Kappelle LJ. Headache in transient or permanent cerebral ischemia. Dutch TIA Study Group. Stroke. 1991;22:754–9.

    Article  CAS  PubMed  Google Scholar 

  21. 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:e1–3.

    Article  PubMed  Google Scholar 

  22. Portenoy RK, Abissi CJ, Lipton RB, Berger AR, Mebler MF, Baglivo J, et al. Headache in cerebrovascular disease. Stroke. 1984;15:1009–12.

    Article  CAS  PubMed  Google Scholar 

  23. Evans RW, Mitsias PD. Headache at onset of acute cerebral ischemia. Headache. 2009;49:902–8. A well-summarized review article of headache in ischemic stroke, including references to key prospective studies, well-researched descriptions of headache, and proposed mechanisms of headache in stroke.

    Article  PubMed  Google Scholar 

  24. Wells CE. Premonitory symptoms of cerebral embolism. Arch Neurol. 1961;5:490–6.

    Article  CAS  PubMed  Google Scholar 

  25. Arboix A, Massons J, Oliveres M, Arribas MP, Titus F. Headache in acute cerebrovascular disease: a prospective clinical study in 240 patients. Cephalalgia. 1994;14:37–40.

    Article  CAS  PubMed  Google Scholar 

  26. Maino A, Algra A, Koudstaal PJ, van Zwet EW, Ferrari MD, Wermer MJ, et al. Concomitant headache influences long-term prognosis after acute cerebral ischemia of noncardioembolic origin. Stroke. 2013;44:2446–50.

    Article  PubMed  Google Scholar 

  27. Vestergaard K, Andersen G, Nielsen MI, Jensen TS. Headache in stroke. Stroke. 1993;24:1621–4.

    Article  CAS  PubMed  Google Scholar 

  28. Chen PK, Chiu PY, Tsai IJ, Tseng HP, Chen JR, Yeh SJ, et al. Onset headache predicts good outcome in patients with first-ever ischemic stroke. Stroke. 2013;44:1852–8. One of the largest scale prospective cohort studies in the literature evaluating the prognosis of patients with onset headache in stroke. The Taiwan Stroke Registry was used to evaluate frequency of stroke in evolution, change in NIHSS, and functional outcome after first-ever ischemic stroke.

    Article  PubMed  Google Scholar 

  29. Nardi K, Parnetti L, Pieri ML, Eusebi P, Calabresi P, Sarchielli P. Association between migraine and headache attributed to stroke: a case-control study. Headache. 2008;48:1468–75.

    Article  PubMed  Google Scholar 

  30. Schwedt TJ, Dodick DW. Thunderclap stroke: embolic cerebellar infarcts presenting as thunderclap headache. Headache. 2006;46:520–2.

    Article  PubMed  Google Scholar 

  31. Edvardsson B. Thunderclap headache as the primary clinical feature of a supratentorial embolic cerebral infarct. Neurol Sci. 2012;33:1489–90.

    Article  PubMed  Google Scholar 

  32. Edvinsson L. Tracing neural connections to pain pathways with relevance to primary headaches. Cephalalgia. 2011;31:737–47.

    Article  PubMed  Google Scholar 

  33. Moskowitz MA, Buzzi MG, Sakas DE, Linnik MD. Pain mechanisms underlying vascular headaches. Progress Report 1989. Rev Neurol (Paris). 1989;145:181–93.

    CAS  Google Scholar 

  34. 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;22:303–8.

    Article  CAS  PubMed  Google Scholar 

  35. Salvarani C, Brown RD, Hunder GG. Adult primary central nervous system vasculitis. Lancet. 2012;380:767–77.

    Article  PubMed  Google Scholar 

  36. Benseler S, Pohl D. Childhood central nervous system vasculitis. Handb Clin Neurol. 2013;112:1065–78.

    Article  PubMed  Google Scholar 

  37. Berlit P, Kraemer M. Cerebral vasculitis in adults: what are the steps in order to establish the diagnosis? Red flags and pitfalls. Clin Exp Immunol. 2014;175:419–24.

    Article  CAS  PubMed  Google Scholar 

  38. Lopez JI, Holdridge A, Chalela J. Headache and vasculitis. Curr Pain Headache Rep. 2013;17:320.

    Article  PubMed  Google Scholar 

  39. Oon S, Roberts C, Gorelik A, Wicks I, Brand C. Primary angiitis of the central nervous system: experience of a Victorian tertiary-referral hospital. Intern Med J. 2013;43:685–92.

    Article  CAS  PubMed  Google Scholar 

  40. Salvarani C, Brown RD, Calamia KT, Christianson TJ, Weigand SD, Miller DV, et al. Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol. 2007;62:442–51.

    Article  PubMed  Google Scholar 

  41. Salvarani C, Brown RD, Calamia KT, Christianson TJ, Huston J, Meschia JF, et al. Primary central nervous system vasculitis presenting with intracranial hemorrhage. Arthritis Rheum. 2011;63:3598–606.

    Article  PubMed  Google Scholar 

  42. Torralba KD, Colletti PM, Quismorio FP. Spinal subarachnoid hemorrhage in necrotizing vasculitis. J Rheumatol. 2008;35:180–2.

    PubMed  Google Scholar 

  43. Tang SC, Lee CF, Lee CW, Jeng JS. Systemic lupus erythematosus flare up manifestation as cerebral and spinal subarachnoid hemorrhage. Lupus. 2011;20:1211–3.

    Article  PubMed  Google Scholar 

  44. Go MH, Park JU, Kang JG, Lim YC. Subarachnoid and intracerebral hemorrhage in patients with churg-strauss syndrome: two case reports. J Cerebrovasc Endovasc Neurosurg. 2012;14:255–61.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Cheng YC, Kuo KH, Lai TH. A common cause of sudden and thunderclap headaches: reversible cerebral vasoconstriction syndrome. J Headache Pain. 2014;15:13.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Ducros A. Reversible cerebral vasoconstriction syndrome. Handb Clin Neurol. 2014;121:1725–41.

    Article  PubMed  Google Scholar 

  47. Mawet J, Boukobza M, Franc J, Sarov M, Arnold M, Bousser MG, et al. Reversible cerebral vasoconstriction syndrome and cervical artery dissection in 20 patients. Neurology. 2013;81:821–4.

    Article  PubMed  Google Scholar 

  48. Chen SP, Fuh JL, Lirng JF, Chang FC, Wang SJ. Recurrent primary thunderclap headache and benign CNS angiopathy: spectra of the same disorder? Neurology. 2006;67:2164–9.

    Article  PubMed  Google Scholar 

  49. Singhal AB, Hajj-Ali RA, Topcuoglu MA, Fok J, Bena J, Yang D, et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol. 2011;68:1005–12.

    Article  PubMed  Google Scholar 

  50. Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 2008;29:1043–9.

    Article  CAS  PubMed  Google Scholar 

  51. Marra A, Vargas M, Striano P, Del Guercio L, Buonanno P, Servillo G. Posterior reversible encephalopathy syndrome: the endothelial hypotheses. Med Hypotheses. 2014;82:619–22.

    Article  CAS  PubMed  Google Scholar 

  52. Kastrup O, Schlamann M, Moenninghoff C, Forsting M, Goericke S. Posterior reversible encephalopathy syndrome: the spectrum of MR imaging patterns. Clin Neuroradiol. 2014. doi:10.1007/s00062-014-0293-7

  53. Yoon SD, Cho BM, Oh SM, Park SH, Jang IB, Lee JY. Clinical and radiological spectrum of posterior reversible encephalopathy syndrome. J Cerebrovasc Endovasc Neurosurg. 2013;15:206–13.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol. 2008;29:1036–42.

    Article  CAS  PubMed  Google Scholar 

  55. McKinney AM, Jagadeesan BD, Truwit CL. Central-variant posterior reversible encephalopathy syndrome: brainstem or basal ganglia involvement lacking cortical or subcortical cerebral edema. AJR Am J Roentgenol. 2013;201:631–8.

    Article  PubMed  Google Scholar 

  56. Osman Y, Imam YZ, Salem K, Al-Hail H, Uthman B, Deleu D. Isolated brainstem involvement in a patient with hypertensive encephalopathy. Case Rep Neurol Med. 2013;2013:540947.

    CAS  PubMed Central  PubMed  Google Scholar 

  57. Karakis I, Macdonald JA, Stefanidou M, Kase CS. Clinical and radiological features of brainstem variant of hypertensive encephalopathy. J Vasc Interv Neurol. 2009;2:172–6.

    PubMed Central  PubMed  Google Scholar 

  58. Hefzy HM, Bartynski WS, Boardman JF, Lacomis D. Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol. 2009;30:1371–9.

    Article  CAS  PubMed  Google Scholar 

  59. McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol. 2007;189:904–12.

    Article  PubMed  Google Scholar 

  60. Legriel S, Schraub O, Azoulay E, Hantson P, Magalhaes E, Coquet I, et al. Determinants of recovery from severe posterior reversible encephalopathy syndrome. PLoS One. 2012;7:e44534.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Leira R, Castellanos M, Alvarez-Sabín J, Diez-Tejedor E, Dávalos A, Castillo J, et al. Headache in cerebral hemorrhage is associated with inflammatory markers and higher residual cavity. Headache. 2005;45:1236–43.

    Article  PubMed  Google Scholar 

  62. Melo TP, Pinto AN, Ferro JM. Headache in intracerebral hematomas. Neurology. 1996;47:494–500.

    Article  CAS  PubMed  Google Scholar 

  63. Abadie V, Jacquin A, Daubail B, Vialatte AL, Lainay C, Durier J, et al. Prevalence and prognostic value of headache on early mortality in acute stroke: the Dijon Stroke Registry. Cephalalgia. 2014. doi:10.1177/0333102414523340

  64. Hu YZ, Wang JW, Luo BY. Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou, China. J Zhejiang Univ Sci B. 2013;14:496–504.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Linn FH, Rinkel GJ, Algra A, van Gijn J. Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. J Neurol Neurosurg Psychiatry. 1998;65:791–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  66. Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Hohl CM, Sutherland J, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013;310:1248–55.

    Article  CAS  PubMed  Google Scholar 

  67. Beck J, Raabe A, Szelenyi A, Berkefeld J, Gerlach R, Setzer M, et al. Sentinel headache and the risk of rebleeding after aneurysmal subarachnoid hemorrhage. Stroke. 2006;37:2733–7.

    Article  PubMed  Google Scholar 

  68. Saposnik G, Barinagarrementeria F, Brown RD, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.

    Article  PubMed  Google Scholar 

  69. Timóteo Â, Inácio N, Machado S, Pinto AA, Parreira E. Headache as the sole presentation of cerebral venous thrombosis: a prospective study. J Headache Pain. 2012;13:487–90.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Gameiro J, Ferro JM, Canhão P, Stam J, Barinagarrementeria F, Lindgren A, et al. Prognosis of cerebral vein thrombosis presenting as isolated headache: early vs. late diagnosis. Cephalalgia. 2012;32:407–12.

    Article  PubMed  Google Scholar 

  71. Pongmoragot J, Saposnik G. Intracerebral hemorrhage from cerebral venous thrombosis. Curr Atheroscler Rep. 2012;14:382–9.

    Article  CAS  PubMed  Google Scholar 

  72. Crovetto F, Somigliana E, Peguero A, Figueras F. Stroke during pregnancy and pre-eclampsia. Curr Opin Obstet Gynecol. 2013;25:425–32.

    Article  PubMed  Google Scholar 

  73. Melhado EM, Maciel JA, Guerreiro CA. Headache during gestation: evaluation of 1101 women. Can J Neurol Sci. 2007;34:187–92.

    PubMed  Google Scholar 

  74. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1545–88

  75. Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elkind MS. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med. 2014;370:1307–15. This recently published paper found that among 1,687,930 women with a first recorded delivery, an elevated risk of thrombosis persisted until at least 12 weeks after delivery. However, the absolute increase in risk beyond 6 weeks after delivery was low.

    Article  CAS  PubMed  Google Scholar 

  76. Kuklina EV, Tong X, Bansil P, George MG, Callaghan WM. Trends in pregnancy hospitalizations that included a stroke in the United States from 1994 to 2007: reasons for concern? Stroke. 2011;42:2564–70.

    Article  PubMed  Google Scholar 

  77. Wasay M, Saadatnia M, Venketasubramanian N, Kaul S, Menon B, Gunaratne P, et al. Predictors of cerebral venous thrombosis and arterial ischemic stroke in young Asian women. J Stroke Cerebrovasc Dis. 2012;21:689–94.

    Article  PubMed  Google Scholar 

  78. Gynecologists ACoOa, Pregnancy TFoHi. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122–31.

    Article  Google Scholar 

  79. Wang IK, Chang SN, Liao CC, Liang CC, Chang CT, Lin HH, et al. Hypertensive disorders in pregnancy and preterm delivery and subsequent stroke in Asian women: a retrospective cohort study. Stroke. 2011;42:716–21.

    Article  PubMed  Google Scholar 

  80. Marozio L, Facchinetti F, Allais G, Nappi RE, Enrietti M, Neri I, et al. Headache and adverse pregnancy outcomes: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2012;161:140–3.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Dr. Dara G. Jamieson, Dr. Natalie T. Cheng, and Dr. Maryna Skliut each declare no potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Weill Cornell Medical College, New York Presbyterian Hospital, 428 East 72nd Street, Suite 400, New York, NY, 10021, USA

    Dara G. Jamieson

  2. Department of Neurology and Neuroscience, New York-Presbyterian Hospital – Weill Cornell Medical Center, 525 East 68th Street, Suite F-610, New York, NY, 10065, USA

    Natalie T. Cheng

  3. Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, 10 Union Square E, Suite 5D, New York, NY, 10003, USA

    Maryna Skliut

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  1. Dara G. Jamieson
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  2. Natalie T. Cheng
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Correspondence to Dara G. Jamieson.

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This article is part of the Topical Collection on Secondary Headache

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Jamieson, D.G., Cheng, N.T. & Skliut, M. Headache and Acute Stroke. Curr Pain Headache Rep 18, 444 (2014). https://doi.org/10.1007/s11916-014-0444-1

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