Headache after ischemic stroke [Neurosurgery Wiki]

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====== Headache after ischemic stroke ======

===== Epidemiology =====

[[Observational]] studies indicate that 15 to 40% of patients with acute [[ischemic stroke]] report headache in close temporal relation to the event. The onset headache is more often seen in [[posterior circulation stroke]]s than in strokes in other vascular territories. [[Transient ischemic attack]]s (TIA) can also lead to [[headache]]. The pathophysiology of headache associated with acute ischemic stroke includes edema, hemorrhagic transformation, and changes in the trigeminovascular system
((Diener HC, Katsarava Z, Weimar C. Headache associated with ischemic cerebrovascular disease. Rev Neurol (Paris). 2008 Oct;164(10):819-24. doi: 10.1016/j.neurol.2008.07.008. Epub 2008 Aug 28. PMID: 18760431.)).
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The prevalence of [[Headache]] after [[ischemic stroke]] is high in [[China]]. In addition, [[women]], presence of [[midbrain lesion]]s, [[posterior circulation stroke]] and a history of [[migraine]] were high-risk factors for ischemic stroke-related headaches
((Xie Q, Wu Y, Pei J, Gao Q, Guo Q, Wang X, Zhong J, Su Y, Zhao J, Zhang L, Dou X. Prevalence and risk factors of ischemic stroke-related headache in China: a systematic review and meta-analysis. BMC Public Health. 2022 Aug 11;22(1):1533. doi: 10.1186/s12889-022-13917-z. PMID: 35953857.)).

===== Diagnosis =====
The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for [[sentinel headache]] before ischemic stroke do not exist
((Lebedeva ER, Ushenin AV, Gurary NM, Gilev DV, Olesen J. Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke. J Headache Pain. 2022 Jan 20;23(1):11. doi: 10.1186/s10194-021-01372-x. PMID: 35057731; PMCID: PMC8903596.))

===== Treatment =====
No clinical trials on poststroke headache treatments were found in this review of the literature. While tricyclic antidepressants and anticonvulsants have been suggested for [[central poststroke pain]] syndrome, there is a regrettable lack of evidence supporting the use of daily medications aimed at reducing poststroke headache frequency. 
((Harriott AM, Karakaya F, Ayata C. Headache after ischemic stroke: A systematic review and meta-analysis. Neurology. 2020 Jan 7;94(1):e75-e86. doi: 10.1212/WNL.0000000000008591. Epub 2019 Nov 6. PMID: 31694924; PMCID: PMC7011689.)).

Better understanding of headache associated with ischemic stroke is needed to establish [[ischemic stroke treatment]] [[guideline]]s and inform patient [[management]]
((Harriott AM, Karakaya F, Ayata C. Headache after ischemic stroke: A systematic review and meta-analysis. Neurology. 2020 Jan 7;94(1):e75-e86. doi: 10.1212/WNL.0000000000008591. Epub 2019 Nov 6. PMID: 31694924; PMCID: PMC7011689.))


===== Outcome =====

Headache is common at the onset of or shortly following [[ischemic stroke]] and may contribute to poststroke [[morbidity]]
((Harriott AM, Karakaya F, Ayata C. Headache after ischemic stroke: A systematic review and meta-analysis. Neurology. 2020 Jan 7;94(1):e75-e86. doi: 10.1212/WNL.0000000000008591. Epub 2019 Nov 6. PMID: 31694924; PMCID: PMC7011689.)). 

Factors associated with diagnostic process failures did not increase the odds of subsequent ischemic stroke/TIA hospitalization following ED headache
((Liberman AL, Lu J, Wang C, Cheng NT, Moncrieffe K, Lipton RB. Factors associated with hospitalization for ischemic stroke and TIA following an emergency department headache visit. Am J Emerg Med. 2021 Aug;46:503-507. doi: 10.1016/j.ajem.2020.10.082. Epub 2020 Nov 7. PMID: 33191047; PMCID: PMC8102647.))