Andrea M Harriott1, Fahri Karakaya2, Cenk Ayata2. 1. From the Neurovascular Research Laboratory (A.M.H., C.A.), Department of Radiology, Massachusetts General Hospital, Charlestown; Vascular Division (A.M.H., C.A.) and Headache and Neuropathic Pain Division (A.M.H.), Department of Neurology, Massachusetts General Hospital, Boston; and University of Massachusetts Dartmouth (F.K.). aharriott@mgh.harvard.edu. 2. From the Neurovascular Research Laboratory (A.M.H., C.A.), Department of Radiology, Massachusetts General Hospital, Charlestown; Vascular Division (A.M.H., C.A.) and Headache and Neuropathic Pain Division (A.M.H.), Department of Neurology, Massachusetts General Hospital, Boston; and University of Massachusetts Dartmouth (F.K.).
Abstract
OBJECTIVE: Headache associated with ischemic stroke is poorly understood. To gain further insight, we systematically reviewed studies examining the prevalence and characteristics of new-onset poststroke headache. METHODS: Medline and PubMed databases were queried. A total of 1,812 articles were identified. Of these, 50 were included in this systematic review. Twenty were included in a meta-analysis and meta-regression. RESULTS: Headache occurred in 6%-44% of the ischemic stroke population. Most headaches had tension-type features, were moderate to severe, and became chronic in nature. Meta-analysis using an inverse-variance heterogeneity model revealed a pooled prevalence of 0.14 (95% confidence interval [CI] 0.07-0.23) with heterogeneity among studies. Metaregression revealed a significant association between prevalence and study location, the source population's national human development index (HDI), and study quality. We found higher prevalence in European (0.22, 95% CI 0.14-0.30) and North American (0.15, 95% CI 0.05-0.26) studies compared with Middle Eastern and Asian studies (0.08, 95% CI 0.01-0.18). However, within each region, populations from countries with higher HDI (p = 0.03) and studies with higher quality (p = 0.001) had lower prevalence. Calculated crude odds ratios (ORs) showed that posterior circulation stroke (pooled OR 1.92, 95% CI 1.4-2.64; n = 7 studies) and female sex (pooled OR 1.25, 95% CI 1.07-1.46; n = 11 studies) had greater odds of headache associated with ischemic stroke. CONCLUSIONS: Taken together, these data suggest that headache is common at the onset of or shortly following ischemic stroke and may contribute to poststroke morbidity. Better understanding of headache associated with ischemic stroke is needed to establish treatment guidelines and inform patient management.
OBJECTIVE: Headache associated with ischemic stroke is poorly understood. To gain further insight, we systematically reviewed studies examining the prevalence and characteristics of new-onset poststroke headache. METHODS: Medline and PubMed databases were queried. A total of 1,812 articles were identified. Of these, 50 were included in this systematic review. Twenty were included in a meta-analysis and meta-regression. RESULTS: Headache occurred in 6%-44% of the ischemic stroke population. Most headaches had tension-type features, were moderate to severe, and became chronic in nature. Meta-analysis using an inverse-variance heterogeneity model revealed a pooled prevalence of 0.14 (95% confidence interval [CI] 0.07-0.23) with heterogeneity among studies. Metaregression revealed a significant association between prevalence and study location, the source population's national human development index (HDI), and study quality. We found higher prevalence in European (0.22, 95% CI 0.14-0.30) and North American (0.15, 95% CI 0.05-0.26) studies compared with Middle Eastern and Asian studies (0.08, 95% CI 0.01-0.18). However, within each region, populations from countries with higher HDI (p = 0.03) and studies with higher quality (p = 0.001) had lower prevalence. Calculated crude odds ratios (ORs) showed that posterior circulation stroke (pooled OR 1.92, 95% CI 1.4-2.64; n = 7 studies) and female sex (pooled OR 1.25, 95% CI 1.07-1.46; n = 11 studies) had greater odds of headache associated with ischemic stroke. CONCLUSIONS: Taken together, these data suggest that headache is common at the onset of or shortly following ischemic stroke and may contribute to poststroke morbidity. Better understanding of headache associated with ischemic stroke is needed to establish treatment guidelines and inform patient management.
Authors: Ethan S Brandler; Mohit Sharma; Flynn McCullough; David Ben-Eli; Bradley Kaufman; Priyank Khandelwal; Elizabeth Helzner; Richard H Sinert; Steven R Levine Journal: J Stroke Cerebrovasc Dis Date: 2015-07-07 Impact factor: 2.136
Authors: Alberto Maino; Ale Algra; Peter J Koudstaal; Erik W van Zwet; Michel D Ferrari; Marieke J H Wermer Journal: Stroke Date: 2013-07-30 Impact factor: 7.914
Authors: Suhail A R Doi; Jan J Barendregt; Shahjahan Khan; Lukman Thalib; Gail M Williams Journal: Contemp Clin Trials Date: 2015-05-21 Impact factor: 2.226
Authors: Daniela Pinter; Simon Fandler-Höfler; Viktoria Fruhwirth; Lisa Berger; Gerhard Bachmaier; Susanna Horner; Sebastian Eppinger; Markus Kneihsl; Christian Enzinger; Thomas Gattringer Journal: Front Neurol Date: 2022-04-25 Impact factor: 4.086
Authors: Mariam Ali; Hendrikus J A van Os; Nelleke van der Weerd; Jan W Schoones; Martijn W Heymans; Nyika D Kruyt; Marieke C Visser; Marieke J H Wermer Journal: Stroke Date: 2021-12-14 Impact factor: 7.914
Authors: Elena R Lebedeva; Anton V Ushenin; Natalia M Gurary; Denis V Gilev; Nadezda V Kislyak; Jes Olesen Journal: J Headache Pain Date: 2022-08-17 Impact factor: 8.588