Felipe Araujo Andrade Oliveira1, Pedro Augusto Sampaio Rocha-Filho2,3. 1. Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil. 2. Department of Neuropsychiatry, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil. 3. Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil.
Abstract
INTRODUCTION: Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of cerebrovascular disease. METHOD: This is a narrative review. RESULTS: The prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% of cases and of headache attributed to transient ischemic attack, from 26% to 36%. Headache attributed to ischemic stroke is more frequent in younger patients, in migraineurs, in those who have suffered a larger stroke, a posterior circulation infarction, or a cortical infarction, and is less frequent in lacunar infarctions. The most common pattern of headache attributed to ischemic stroke is a mild to moderate bilateral pain, not associated with nausea, vomiting, photophobia, or phonophobia. This headache usually has a concomitant onset with focal neurologic deficit and improves over time. The few studies that have assessed the value of headache for a prognosis of ischemic strokes have demonstrated conflicting results. There are no clinical trials on pain management or prophylactic treatment of persistent headache attributed to ischemic stroke. CONCLUSION: Headache attributed to ischemic stroke is frequent and usually has a tension-type headache pattern. Its frequency varies according to the stroke's etiology. Further studies are required on pain management, prophylactic treatment, and characteristics of this headache.
INTRODUCTION: Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of cerebrovascular disease. METHOD: This is a narrative review. RESULTS: The prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% of cases and of headache attributed to transient ischemic attack, from 26% to 36%. Headache attributed to ischemic stroke is more frequent in younger patients, in migraineurs, in those who have suffered a larger stroke, a posterior circulation infarction, or a cortical infarction, and is less frequent in lacunar infarctions. The most common pattern of headache attributed to ischemic stroke is a mild to moderate bilateral pain, not associated with nausea, vomiting, photophobia, or phonophobia. This headache usually has a concomitant onset with focal neurologic deficit and improves over time. The few studies that have assessed the value of headache for a prognosis of ischemic strokes have demonstrated conflicting results. There are no clinical trials on pain management or prophylactic treatment of persistent headache attributed to ischemic stroke. CONCLUSION:Headache attributed to ischemic stroke is frequent and usually has a tension-type headache pattern. Its frequency varies according to the stroke's etiology. Further studies are required on pain management, prophylactic treatment, and characteristics of this headache.