Institute of Medical Psychology and Medical Sociology Medical Faculty, University of Rostock, Gehlsheimer, Straße 20, 18147, Rostock, Germany,
J Neural Transm (Vienna). 2013 Oct;120(10):1433-40. doi: 10.1007/s00702-013-1014-0. Epub 2013 Jun 9.
Headache as symptom of stroke is linked to gender, history of migraine, younger age, cerebellar stroke, and low blood pressure. These associations have been controversial, large scale studies are missing. We used the stroke in young fabry patients study to examine the association of demographic, clinical and imaging factors with the occurrence of headache in 4,431 young ischaemic stroke patients (18-55 years; mean: 44.7 years) with an ischemic cerebrovascular event (CVE) (ischemic stroke-IS 75.9%, TIA 24.1%). Headache in males occurred more frequently in bilateral localisation (right/left/bilateral: 27.5, 24.6, 39.2%, p < 0.01), but not in females (40.3, 34.7, 39.6%). Headache occurrence was more often associated in both genders with IS or TIA in the posterior cerebral territory (male: 33.2%, p < 0.05; female: 51.0%, p < 0.01) and vertebrobasilar arteries (male: 44.8%, p < 0.001; female: 51.2%, p < 0.001). The larger the size of the most prominent lesion the more likely patients were complaining headache during the IS (≤1 cm vs. >half lobe: 19.5 vs. 28.4% in male, p < 0.001; 28.9 vs. 39.1% in female, p < 0.01). Binary logistic regression analyses revealed lower age (p < 0.001), female sex (p < 0.001), larger size of the largest lesion (p < 0.001), and localization in the vertebrobasilar territory (p < 0.001) as predictors for headache during CVE. Headache at stroke onset is more common during IS in females, younger patients, with greater size of the acute lesion, and affected in posterior cerebral artery or vertebrobasilar system. Headache is a leading symptom in specific combination of stroke factors. These factors should be taken into account when patients report headache during IS or TIA.
头痛作为中风的症状与性别、偏头痛史、年龄较小、小脑中风和低血压有关。这些关联一直存在争议，缺乏大规模的研究。我们使用年轻 Fabry 患者中风研究，检查了人口统计学、临床和影像学因素与 4431 名年轻缺血性中风患者（18-55 岁；平均年龄 44.7 岁）发生头痛的相关性，这些患者患有缺血性脑血管事件（CVE）（缺血性中风-IS 75.9%，TIA 24.1%）。男性头痛更常发生在双侧定位（右侧/左侧/双侧：27.5%、24.6%、39.2%，p<0.01），而女性则不然（40.3%、34.7%、39.6%）。在两性中，头痛发生更常与大脑后区的 IS 或 TIA 相关（男性：33.2%，p<0.05；女性：51.0%，p<0.01）和椎基底动脉（男性：44.8%，p<0.001；女性：51.2%，p<0.001）。最大病变的大小越大，IS 期间患者越有可能出现头痛（≤1 cm 与>半叶：男性 19.5%与 28.4%，p<0.001；女性 28.9%与 39.1%，p<0.01）。二元逻辑回归分析显示，年龄较小（p<0.001）、女性（p<0.001）、最大病变大小较大（p<0.001）和椎基底动脉受累（p<0.001）是 CVE 期间头痛的预测因素。中风发作时头痛在女性、年轻患者、急性病变较大、大脑后动脉或椎基底动脉系统受累的 IS 中更为常见。头痛是特定中风因素组合的主要症状。当患者在 IS 或 TIA 期间报告头痛时，应考虑这些因素。
