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January 07, 2020; 94 (1) ArticleOpen Access

Headache after ischemic stroke

A systematic review and meta-analysis

Andrea M. Harriott, Fahri Karakaya, Cenk Ayata
First published November 6, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008591
Andrea M. Harriott
From the Neurovascular Research Laboratory (A.M.H., C.A.), Department of Radiology, Massachusetts General Hospital, Charlestown; Vascular Division (A.M.H., C.A.) and Headache and Neuropathic Pain Division (A.M.H.), Department of Neurology, Massachusetts General Hospital, Boston; and University of Massachusetts Dartmouth (F.K.).
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Fahri Karakaya
From the Neurovascular Research Laboratory (A.M.H., C.A.), Department of Radiology, Massachusetts General Hospital, Charlestown; Vascular Division (A.M.H., C.A.) and Headache and Neuropathic Pain Division (A.M.H.), Department of Neurology, Massachusetts General Hospital, Boston; and University of Massachusetts Dartmouth (F.K.).
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Cenk Ayata
From the Neurovascular Research Laboratory (A.M.H., C.A.), Department of Radiology, Massachusetts General Hospital, Charlestown; Vascular Division (A.M.H., C.A.) and Headache and Neuropathic Pain Division (A.M.H.), Department of Neurology, Massachusetts General Hospital, Boston; and University of Massachusetts Dartmouth (F.K.).
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Headache after ischemic stroke
A systematic review and meta-analysis
Andrea M. Harriott, Fahri Karakaya, Cenk Ayata
Neurology Jan 2020, 94 (1) e75-e86; DOI: 10.1212/WNL.0000000000008591

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Abstract

Objective Headache associated with ischemic stroke is poorly understood. To gain further insight, we systematically reviewed studies examining the prevalence and characteristics of new-onset poststroke headache.

Methods Medline and PubMed databases were queried. A total of 1,812 articles were identified. Of these, 50 were included in this systematic review. Twenty were included in a meta-analysis and meta-regression.

Results Headache occurred in 6%–44% of the ischemic stroke population. Most headaches had tension-type features, were moderate to severe, and became chronic in nature. Meta-analysis using an inverse-variance heterogeneity model revealed a pooled prevalence of 0.14 (95% confidence interval [CI] 0.07–0.23) with heterogeneity among studies. Metaregression revealed a significant association between prevalence and study location, the source population's national human development index (HDI), and study quality. We found higher prevalence in European (0.22, 95% CI 0.14–0.30) and North American (0.15, 95% CI 0.05–0.26) studies compared with Middle Eastern and Asian studies (0.08, 95% CI 0.01–0.18). However, within each region, populations from countries with higher HDI (p = 0.03) and studies with higher quality (p = 0.001) had lower prevalence. Calculated crude odds ratios (ORs) showed that posterior circulation stroke (pooled OR 1.92, 95% CI 1.4–2.64; n = 7 studies) and female sex (pooled OR 1.25, 95% CI 1.07–1.46; n = 11 studies) had greater odds of headache associated with ischemic stroke.

Conclusions Taken together, these data suggest that headache is common at the onset of or shortly following ischemic stroke and may contribute to poststroke morbidity. Better understanding of headache associated with ischemic stroke is needed to establish treatment guidelines and inform patient management.

Glossary

CI=
confidence interval;
HAIS=
headache associated with ischemic stroke;
HDI=
human development index;
ICHD=
International Classification of Headache Disorders;
OR=
odds ratio;
QS=
quality score

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. The Article Processing Charge was funded by the authors.

  • Received April 20, 2019.
  • Accepted in final form June 26, 2019.
  • Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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  • Reader response: Headache after ischemic stroke: A systematic review and meta-analysis
    • Vinod K. Gupta, Physician-Director, Migraine-Headache Institution, Gupta Medical Center (New Delhi, India)
    Submitted December 24, 2019
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