Department of Neurology, the Ural State Medical University, Yekaterinburg, Russia.
International Headache Center "Europe-Asia", Yekaterinburg, Russia.
J Headache Pain. 2022 Jan 20;23(1):11. doi: 10.1186/s10194-021-01372-x.
Defining the relationship between a headache and stroke is essential. 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. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache.
This prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache.
Our previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%.
We suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity.
明确头痛与中风之间的关系至关重要。目前，ICHD-3 对急性头痛归因于缺血性中风的诊断标准主要基于专家意见，而不是基于对首次中风患者进行广泛病例对照研究的临床证据。也不存在缺血性中风前先兆性头痛的诊断标准。本研究旨在为缺血性中风引起的头痛和先兆性头痛制定明确的诊断标准。
这是一项前瞻性病例对照研究，纳入了 550 名（平均年龄 63.1 岁，54%为男性）首次发生缺血性中风的患者和 192 名（平均年龄 58.7 岁，36%为男性）因无急性神经功能缺损或严重疾病而入住急诊室的对照患者。在两组患者入院时，由神经科医生通过面对面访谈，使用标准化半结构化访谈表评估既往和现有的头痛。所有头痛均根据 ICHD-3 进行诊断。我们记录了首次发生缺血性中风前和中风发作时不同头痛的发作情况。我们将其分为三组：新类型头痛、特征改变的既往头痛和既往未改变的头痛。在对照组中，我们也在入院前一周和入院时进行了相同的头痛记录。这些数据用于创建和测试急性中风相关头痛和先兆性头痛的诊断标准。
我们之前的研究表明，550 名患者中有 82 名（14.9%）在中风发作时出现头痛，81 名（14.7%）患者在中风前一周内出现先兆性头痛。只有 60%的中风发作时的头痛符合 ICHD-3 的诊断标准。因此，我们提出了具有 100%敏感性和 97%特异性的替代标准。此外，我们首次为先兆性头痛制定了诊断标准，其特异性为 98%，敏感性为 100%。
我们建议为缺血性中风引起的急性头痛和先兆性头痛制定替代诊断标准，这些标准具有较高的敏感性和特异性。
