EP 9. Prevalence, clinical characteristics and long-term course of headache in patients with stroke (multicenter study of DMKG)

Abstract

Background Headache in association with stroke is a symptom not at all differentiated and investigated in Germany. According to previous data, it seems to be a common problem, but usually other symptoms of stroke are predominating. Furthermore, the treatment is focused on acute therapy of ischemic stroke followed by rehabilitation. However, headaches in subarachnoid hemorrhage as a special type of stroke represents the leading clinical symptom and thus also be diagnostically significant. Headache in stroke should be classified as symptomatic headache (IHS 6.1–6.2). Methods Affirmative vote of the ethics committees of all above named study centers. Patients were included within 24 h after onset of stroke symptoms and were interviewed for headache at the first to third Day by a self constructed questionnaire. The follow-up is also made by questionnaire which is completed by the patients themselves after 3, 6 and 12 months. Questionnaires from all the Study centers should be sent back to the Department of Neurology, University of Halle/Saale for central evaluation. Results So far 244 patients were included from which 98 stroke patients complained for headache (40%) at least one of the first three days. This occurred in 45% of female and 36% of male patients. The most common diagnoses were Ischemic stroke with 65% (159/244) and TIA (transient ischemic attack) with 28% (67/244). Headache were complained by 37% (58/159) of the patients with ischemic stroke and 43% (29/67) with TIA. The headache frequency decreases during the first 3 days. After 3 months 201 patients were asked so far, 93 responses (47% return), 35% of them with persistent headache. After 6 months, 81 patients were asked till now, 42 responses (52% return), 27% with persistent headache. Discussion Headache prevalence from day one to three was higher than in previous studies of Ischemic Stroke (27–31%, Hansen et al., 2012) and TIA (24–36%, Carolei et al., 2010). One explanation for the higher percentages could be visiting the patients by always the same person on the first 3 days. One might assume that the patient build a kind of personal bond. Also in course of 3, 6 and 12 months, some patients complain of headaches yet, but the prevalence decreases in that course. Only when all letters are sent for follow-up and enough time has been given for an answer, a final response rate can be determined. We suspect that the return rate is currently still low because some patients have indeed received a letter, but have not yet replied. Furthermore, possible cognitive impairment after a stroke can make it difficult to complete the questionnaires. Further results are expected during the next 12 months.