Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Headache. 2018 Oct;58(9):1442-1453. doi: 10.1111/head.13382. Epub 2018 Aug 27.
Persistent post-stroke headache is a clinical entity that has recently entered the International Classification of Headache Disorders, 3rd edition. In contrast to acute headache attributed to stroke, the epidemiology, clinical features, potential pathophysiology, and management of persistent post-stroke headache have not been reviewed.
We summarize the literature describing persistent headache attributed to stroke.
Persistent headache after ischemic or hemorrhagic stroke affects up to 23% of patients. These persistent headaches tend to have tension-type features and are more frequent and severe than acute stroke-related headaches. Risk factors include younger age, female sex, pre-existing headache disorder, and comorbid post-stroke fatigue or depression. Other factors including obstructive sleep apnea or musculoskeletal imbalances may contribute to headache persistence. Although more evidence is needed, it may be reasonable to treat persistent post-stroke headache according to headache semiology.
Recognition of persistent post-stroke headache as a separate clinical entity from acute stroke-attributed headache is the first step toward better defining its natural history and most effective treatment strategies.
持续性卒后头痛是一种新纳入国际头痛疾病分类第 3 版的临床实体。与归因于卒中的急性头痛不同，持续性卒后头痛的流行病学、临床特征、潜在病理生理学和治疗尚未得到综述。
我们总结了描述卒中后持续性头痛的文献。
缺血性或出血性卒后持续性头痛影响多达 23%的患者。这些持续性头痛往往具有紧张型特征，比急性卒中相关头痛更频繁和严重。危险因素包括年龄较小、女性、既往头痛障碍以及卒中后疲劳或抑郁共病。其他因素，包括阻塞性睡眠呼吸暂停或肌肉骨骼失衡，可能导致头痛持续存在。尽管需要更多的证据，但根据头痛半侧分布特征来治疗持续性卒后头痛可能是合理的。
将持续性卒后头痛视为与急性卒中相关头痛不同的独立临床实体，是更好地确定其自然病程和最有效治疗策略的第一步。
