P 165 Incidence, clinical characteristics and longterm course of headache in patients with stroke (DMKG multicenter study)

Abstract

Background Post stroke headache is a symptom which is generally not further differentiated. According to previous European and American studies, it is a common phenomenon. Nevertheless, other symptoms of stroke, such as palsy or aphasia, are dominating clinical assessments. However, the symptom “headache” can be an essential part of the clinical picture as in subarachnoid bleeding or cerebral venous thrombosis and it is unclear which risk factors modulate the symptoms and the occurrence of headache in stroke. ( Bederson, 2009 , Wasay, 2010 ) Therefore, we planned a prospective multicenter register study with the aim to record the history of the patient, characteristics of headache symptoms and long-term course, as well as the characteristics of stroke. Methods Patients were included within 24 h after onset of stroke symptoms and were interviewed for headache from the 1st to 3rd day with a newly generated questionnaire. For follow-up data collection patients filled in questionnaires after 3, 6 and 12 months. The study was approved by the ethics committees of the study centers. All patients gave their informed consent. Results Until now, 707 stroke patients could be included. The most common diagnoses were ischemic stroke with 67% (470/707) and TIA (transient ischemic attack) with 22% (156/707). Other diagnoses were hemorrhagic stroke (5%), subarachnoid bleeding (0.8%), cerebral venous thrombosis (0.5%) and other diagnoses (4.7%). 277 (40%) patients complained about headache on at least one of the first 3 days. This occurred in 46% of female and 36% of male patients. Headache was complained by 38% (179/470) of the patients with ischemic stroke and 47% (73/156) with TIA. Headache frequency decreased during the first 3 days. Headache intensity was in 67% between NRS 3–6 (NRS 0–10), 19% lower (NRS 1–2) and 14% higher (NRS 7–10). Women suffered more frequently from headache than men (p Discussion Headache incidence from day 1 to 3 is higher than reported previously for ischemic stroke (27–31%) ( Hansen, 2012 ) and TIA (24–36%) ( Carolei, 2010 ). One explanation could be that the patients were consequently asked by the same person at the first 3 days. Headache incidence was still that high, when we removed stroke diagnoses which are well known for headache occurrence (hemorrhagic stroke, cerebral venous thrombosis, subarachnoid bleeding). Risk factors are being female and having a history of primary headaches. Cognitive impairment and depression after stroke could influence the ability to complete the follow-up questionnaires, which might explain the low response rate after 3, 6 and 12 months. We expect to complete the study in the end of 2017 when all follow-up data will have been collected. A first conclusion is, that headache is a frequent symptom in stroke.