Headache in stroke according to National Acute Stroke Israeli Survey

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Many aspects of stroke‐related headache, such as incidence, mechanism, risk factors, and relation to stroke etiology, are uncertain. Headache in acute stroke is usually suggestive of subarachnoid or intracerebral hemorrhage (ICH).1 However, observational studies indicate that 8%–64% of patients with acute ischemic stroke (IS) report headache at stroke onset.4 Moreover, transient ischemic attacks (TIA) can also present with headache.2
Previous history of migraine, younger age, and female gender have been independently associated with headache at the onset of IS.4 The higher frequency of headache with infarcts of the posterior circulation, mainly of the cerebellum, has also been repeatedly reported.4 Headache at stroke onset has even been associated with better outcomes after IS.10 However, most reported data are not consistent and sometimes controversial. This might be due to the difficulties encountered in headache assessment in the emergency situation of stroke, inclusion criteria, or methods.
Characterization of headache in different stroke subtypes might be of clinical value and help in clarification of stroke mechanisms. Therefore, clinical surveys of large cohorts of patients with acute stroke and headache might contribute to the elucidation of this issue. We performed an analysis of headache prevalence in a large cohort of patients with acute stroke trying to confirm several former reports and reveal some new aspects.

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