Headache at onset of first-ever ischemic stroke: Clinical characteristics and predictors

No studies have prospectively investigated headache at onset of first-ever ischemic stroke along with a large concurrent control group. Our aims were to answer two important questions: (i) Are headaches at stroke onset causally related to the stroke, and what are their typical clinical characteristics? (ii) What etiology of stroke is associated with these headaches? The study population consisted of 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 serious disorders. All data were collected prospectively, using a standardized case-report form during face-to-face interviews by neurologists. Headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients. More than half (56%) had a new type of headache (mainly migraine-like) simultaneously with stroke onset, and 36% had headache with altered characteristics (mainly tension-type-like headache). Headaches were associated with cardioembolism (p = 0.002, odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.4-4.1), posterior circulation stroke (p = 0.01, OR = 2.0, 95% CI = 1.2-3.5), infarcts >15 mm (p = 0.03, 95% CI = 1.1-2.7), infarcts of the cerebellum (p = 0.02, OR = 2.3, 95% CI = 1.1-4.8), good neurological status (p = 0.01, OR = 2.5, 95% CI = 1.2-4.9), and low frequency of large-artery atherosclerosis (p = 0.004, OR = 0.4, 95% CI = 0.2-0.8). At stroke onset, headache of a new type and headache with altered characteristics were related to ischemic stroke. They were associated with certain etiologies of stroke.