Neurology Service, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
Unidade de Saúde Familiar Monte Pedral, Agrupamento de Centros de Saúde Lisboa Central, Administração Regional de Saúde Lisboa e Vale do Tejo, Lisboa, Portugal.
Headache. 2020 Mar;60(3):607-614. doi: 10.1111/head.13761. Epub 2020 Feb 5.
Headache in ischemic stroke survivors after the acute stage is incompletely described.
We aimed to prospectively describe the characteristics of headache and the predictors of headache at the chronic stage after ischemic stroke.
We conducted a prospective observational cohort study including 102 acute ischemic stroke patients admitted to a Stroke Unit. Patients were interviewed at the acute and the chronic stage (12 months after stroke). Characteristics of those headaches were collected using a previously validated headache questionnaire enabling headache classification following the International Headache Society criteria. Pre-stroke headache history was registered using the same instrument.
Forty-five patients out of 89 with completed follow-up (51%) reported headache at the chronic stage. In most of the patients, headache was sporadic, mild, pressure-like, with a duration of minutes to hours, with characteristics of tension-type headache in 51% (n = 23/45). Headache was a reactivation of pre-stroke headache in 33% (n = 15/45), different from pre-stroke headache in 44% (n = 20/45), and of new-onset in 22% (n = 10/45). Only 1 patient had a new-onset headache at the acute stage that persisted with the same characteristics at the chronic stage. Pre-stroke headache (OR = 5.3; 95% CI [2.01-13.98] P = .001) and female sex (OR = 3.5; 95% CI [1.3-9.4] P = .013) predicted headache at the chronic stage after stroke, controlling for age, severity, and location of stroke.
Headache in ischemic stroke survivors at the chronic stage is more frequent in women and in patients with pre-stroke headache. It is most frequently a headache with different characteristics of the pre-stroke headache and only rarely a new-onset headache starting at the acute stage and persisting at the chronic stage.
急性阶段后缺血性中风幸存者的头痛描述并不完整。
我们旨在前瞻性描述缺血性中风后慢性阶段头痛的特征和头痛的预测因素。
我们进行了一项前瞻性观察队列研究，纳入了 102 名入住中风病房的急性缺血性中风患者。在急性和慢性阶段（中风后 12 个月）对患者进行了访谈。使用先前验证的头痛问卷收集这些头痛的特征，该问卷允许根据国际头痛协会标准对头痛进行分类。使用相同的工具记录了卒中前头痛史。
在完成随访的 89 名患者中，有 45 名（51%）报告在慢性阶段出现头痛。在大多数患者中，头痛是偶发性的、轻度的、压迫样的，持续数分钟至数小时，51%（n=23/45）具有紧张型头痛的特征。头痛是卒中前头痛的复发，占 33%（n=15/45），与卒中前头痛不同，占 44%（n=20/45），新发头痛占 22%（n=10/45）。仅有 1 名患者在急性阶段出现新发头痛，其特征在慢性阶段持续存在。卒中前头痛（OR=5.3；95%CI[2.01-13.98]；P=0.001）和女性（OR=3.5；95%CI[1.3-9.4]；P=0.013）是卒中后慢性阶段头痛的预测因素，控制了年龄、严重程度和卒中部位。
缺血性中风幸存者在慢性阶段的头痛更为常见，且在有卒中前头痛的患者中更为常见。它最常是一种具有与卒中前头痛不同特征的头痛，很少是一种新发头痛，从急性阶段开始并持续到慢性阶段。
