Jørgensen H S, Jespersen H F, Nakayama H, Raaschou H O, Olsen T S
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Neurology. 1994 Oct;44(10):1793-7. doi: 10.1212/wnl.44.10.1793.
Many aspects of stroke-related headache, such as its incidence, pathophysiology, risk factors, and relation to stroke severity and outcome, are uncertain.
A prospective, community-based study including 1,128 consecutive acute stroke patients; 867 (77%) were able to communicate. Stroke severity and the clinical course were assessed using the Scandinavian Stroke Scale (SSS). CT was performed in 84% of patients. In the data analysis, multivariate regression analyses were used when appropriate.
Two hundred forty-one (28%) of the 867 patients had headache in relation to stroke onset. Independent risk factors were age (odds ratio [OR] per 20 years, 0.57; 95% confidence interval [CI], 0.43 to 0.86; p = 0.0001), female sex (OR, 1.6; CI, 1.2 to 2.2; p = 0.003), intracerebral hemorrhage (OR, 2.8; CI, 1.5 to 5.4; p = 0.002), stroke in the vertebrobasilar territory (OR, 1.7; CI, 1.1 to 2.3; p = 0.02), and ischemic heart disease (OR, 1.5; CI, 1.1 to 2.2; p = 0.01). In those patients in whom headache was lateralized (46%), it was ipsilateral to the lesion in 68% of cases (p = 0.01). There was no correlation between headache and (1) initial stroke severity as measured with the SSS (p = 0.75), (2) lesion size (p = 0.77), (3) whether or not CT showed cortical involvement (p = 0.29), (4) stroke outcome as measured with the SSS (p = 0.9), or (5) mortality (p = 0.75).
Stroke-related headache is associated with factors such as age and sex. In patients capable of providing reliable headache information, headache is more frequent in strokes confined to the vertebrobasilar than to the carotid territory and is not associated with stroke severity or whether or not the cortex was involved. Stroke-related headache is not related to stroke outcome.
与中风相关的头痛的许多方面，如发病率、病理生理学、危险因素以及与中风严重程度和预后的关系，都尚不确定。
一项基于社区的前瞻性研究，纳入了1128例连续的急性中风患者；其中867例（77%）能够进行交流。使用斯堪的纳维亚中风量表（SSS）评估中风严重程度和临床病程。84%的患者进行了CT检查。在数据分析中，酌情使用多因素回归分析。
867例患者中有241例（28%）在中风发作时出现头痛。独立危险因素包括年龄（每20岁的比值比[OR]为0.57；95%置信区间[CI]为0.43至0.86；p = 0.0001）、女性（OR为1.6；CI为1.2至2.2；p = 0.003）、脑出血（OR为2.8；CI为1.5至5.4；p = 0.002）、椎基底动脉区域中风（OR为1.7；CI为1.1至2.3；p = 0.02）以及缺血性心脏病（OR为1.5；CI为1.1至2.2；p = 0.01）。在那些头痛定位的患者中（46%），68%的病例头痛与病变同侧（p = 0.01）。头痛与以下因素之间无相关性：（1）用SSS测量的初始中风严重程度（p = 0.75），（2）病变大小（p = 0.77），（3）CT是否显示皮质受累（p = 0.29），（4）用SSS测量的中风预后（p = 0.9），或（5）死亡率（p = 0.75）。
与中风相关的头痛与年龄和性别等因素有关。在能够提供可靠头痛信息的患者中，局限于椎基底动脉的中风比颈动脉区域的中风更常出现头痛，且与中风严重程度或皮质是否受累无关。与中风相关的头痛与中风预后无关。
