Headache attributed to ischemic stroke: prevalence, phenotypes, and analysis of associated factors

Abstract

Background: Headache at the onset of acute ischemic stroke may point to specific vascular etiologies, yet the features and risk factors of headache attributed to ischemic stroke remain under-characterized. This study aimed to determine the prevalence, clinical phenotype, and independent predictors of acute headache attributed to ischemic stroke. Methods: In this cross-sectional study, consecutive adults with acute ischemic stroke admitted to a Thai university hospital (July 2021 – December 2022) underwent a structured headache interview based on the International Classification of Headache Disorders, 3rd edition. Infarct topography was mapped with the Alberta Stroke Program Early CT Score. Multivariable logistic regression identified factors independently associated with acute headache attributed to ischemic stroke. Results: Among 153 patients, 35 experienced acute headache attributed to ischemic stroke (prevalence 23%). Headache was usually mild (54%); pressing or tightening in character (46%); bilateral (51%) or ipsilateral to the infarct (31%); centered on the temporal region (66%); intermittent (54%); and typically lacked accompanying symptoms (66%). Female sex (adjusted odds ratio [aOR] 2.54, 95% confidence interval [CI] 1.10–5.85), large-artery atherosclerosis (aOR 2.56, 95% CI 1.09–6.01), and lentiform nucleus infarction (aOR 3.78, 95% CI 1.25–11.44) independently increased the odds of acute headache attributed to ischemic stroke. Conclusions: Nearly one in four patients with acute ischemic stroke experienced acute headache attributed to ischemic stroke, characteristically a mild, tension-type pain that was bilateral or lateralized to the ischemic hemisphere, centered on the temporal region. Female sex, large-artery atherosclerosis, and lentiform nucleus involvement were independent risk factors.