Headache at stroke onset in 2196 patients with ischemic stroke or transient ischemic attack

Background and Purpose - Headache is a common symptom in acute ischemic and hemorrhagic stroke, but many aspects of its association with other clinical factors are controversial. Methods - We analyzed characteristics of headache symptoms at stroke onset and associations between headache at stroke onset and at several clinical parameters in 2196 patients experiencing ischemic stroke or transient ischemic attack within a multicenter hospital-based stroke registry. Results - Five hundred eighty-eight (27%) patients experienced headache at stroke onset. In a multivariate analysis, headache at stroke onset was positively associated with female sex, history of migraine, younger age, cerebellar stroke ( but not with other brain stem locations), and blood pressure values on admission < 120 mm Hg systolic and < 70 mm Hg diastolic. It showed no significant association with stroke severity measured by the modified Rankin Scale at days 5 to 7 after the event, presumed etiology, or time of day. Conclusions - Our results, derived from a large number of systematically documented patients with acute ischemic cerebrovascular events, show no association of headache with stroke etiology or outcome. Our results indicate that the previously described association of headache with vertebrobasilar stroke is mainly because of its association with cerebellar stroke. We could confirm previously described associations of headache at stroke onset with younger age and a history of migraine, implicating a careful evaluation of young patients with a focal neurological deficit and a history of migraine to avoid misclassification as "complicated migraine."