Ferro J M, Melo T P, Oliveira V, Salgado A V, Crespo M, Canhão P, Pinto A N
Servico de Neurologia, Hospital de Santa Maria, Faculdade de Medicina de Lisboa, Portugal.
Headache. 1995 Jun;35(6):315-9. doi: 10.1111/j.1526-4610.1995.hed3506315.x.
Thirty-four percent of 182 ischemic stroke patients registered during 1 year in a prospective hospital stroke data base complained of headache within a 72-hour interval of stroke onset. Headache was more common in patients under 70 years of age, in nonsmokers, in those with a past history of migraine, and in subjects presenting transient loss of consciousness, nausea/vomiting, or visual field defects. Headache was more frequent in vertebrobasilar (57%) than in carotid (20%) territory strokes, more so in posterior cerebral artery (90%) and cerebellar infarcts (80%), and was infrequent in subcortical infarcts (7%) and lacunes due to single perforator disease (9%). In multiple regression analysis, vertebrobasilar stroke (odds ratio 6.9), lacuanr stroke (odds ratio 0.06), and past history of migraine (odds ratio 6.7) were significant independent predictors of headache, suggesting that ischemic stroke location is the major determinant of stroke-associated headache, most probably related to activation of the trigeminovascular system, whose threshold may be modified by individual susceptibility.
在一家医院前瞻性卒中数据库中登记的182例缺血性卒中患者中，34%在卒中发作72小时内出现头痛。头痛在70岁以下患者、不吸烟者、有偏头痛病史者以及出现短暂意识丧失、恶心/呕吐或视野缺损的患者中更为常见。椎基底动脉供血区卒中（57%）的头痛发生率高于颈动脉供血区卒中（20%），在大脑后动脉梗死（90%）和小脑梗死（80%）中更为频繁，而在皮质下梗死（7%）和单一穿支动脉疾病所致腔隙性梗死（9%）中则较少见。在多元回归分析中，椎基底动脉卒中（比值比6.9）、腔隙性卒中（比值比0.06）和偏头痛病史（比值比6.7）是头痛的显著独立预测因素，提示缺血性卒中的部位是卒中相关性头痛的主要决定因素，很可能与三叉神经血管系统的激活有关，其阈值可能因个体易感性而改变。
