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 strokes than in strokes in other vascular territories. Transient ischemic attacks (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 1).
The prevalence of Headache after ischemic stroke is high in China. In addition, women, presence of midbrain lesions, posterior circulation stroke and a history of migraine were high-risk factors for ischemic stroke-related headaches 2).
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 3)
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. 4).
Better understanding of headache associated with ischemic stroke is needed to establish ischemic stroke treatment guidelines and inform patient management 5)
Headache is common at the onset of or shortly following ischemic stroke and may contribute to poststroke morbidity 6).
Factors associated with diagnostic process failures did not increase the odds of subsequent ischemic stroke/TIA hospitalization following ED headache 7)