Conflict of Interest: None
Association Between Migraine and Headache Attributed to Stroke: A Case–Control Study
Version of Record online: 9 MAY 2008
© 2008 the Authors. Journal compilation © 2008 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 48, Issue 10, pages 1468–1475, November/December 2008
How to Cite
Nardi, K., Parnetti, L., Pieri, M. L., Eusebi, P., Calabresi, P. and Sarchielli, P. (2008), Association Between Migraine and Headache Attributed to Stroke: A Case–Control Study. Headache: The Journal of Head and Face Pain, 48: 1468–1475. doi: 10.1111/j.1526-4610.2008.01137.x
- Issue online: 19 NOV 2008
- Version of Record online: 9 MAY 2008
- Accepted for publication February 2, 2008.
- cerebral infarction;
- headache attributed to ischemic stroke
Background.— Several studies were carried out to investigate the occurrence of headache attributed to acute stroke in patients with a lifetime history of migraine.
Methods.— In a case–control series of 96 acute stroke patients with a lifetime history of migraine (M+) and 96 stroke patients without (M−), ischemic stroke patients only, without secondary infarction, were selected. The headache attributed to acute ischemic stroke was then analyzed.
Results.— (M+) patients complained of headache more often than (M−) patients (P < .0001), mainly in the 24 hours before stroke onset (P < .0001). Migraine-like features of headache were recognized in a greater proportion of cases in the (M+) patient group with ischemic stroke (P < .018). A preferential brainstem location of ischemic stroke in (M+) patients emerged compared with (M−) patients (P = .014).
Discussion.— The high prevalence of headache attributed to stroke in (M+) patients, in a relevant proportion of cases presenting as a sentinel headache, suggests that cerebral ischemia lowers the threshold for head pain more easily in these “susceptible” patients. The most frequent involvement of the brainstem in (M+) patients with ischemic infarction concurs with recent reports that emphasized a greater headache frequency when cerebral infarctions are localized in this structure or deep brain gray matter.