Headache at the onset of stroke: Frequencies, background characteristics and correlation with mortality
Kazuo Shigematsu, Hiromi Nakano, Yoshiyuki Watanabe, Tatsuyuki Sekimoto, Kouichiro Shimizu, Akihiko Nishizawa, Atsushi Okumura, Masahiro Makino, Touru Seki, Kazuhiko Bando, Yasushi Kitagawa
Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Department of Internal Medicine, The Bando Clinic, Kyoto, Japan.
Department of Internal Medicine, The Kitagawa Clinic, Kyoto, Japan.
Department of Internal Medicine, The Nishizawa Clinic, Kyoto, Japan.
Department of Internal Medicine, The Seki Clinic, Kyoto, Japan.
Department of Neurology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
Department of Neurology, National Hospital Organization, Minami Kyoto Hospital, Kyoto, Japan.
Department of Neurosurgery, Jujyo Rehabilitation Hospital, Kyoto, Japan.
Department of Neurosurgery, Kyoto Fushimi Shimizu Hospital, Kyoto, Japan.
Department of Neurosurgery, Kyoto Kidugawa Hospital, Kyoto, Japan.
Department of Neurosurgery, Kyoto Prefectural Yosanoumi Hospital, Kyoto, Japan.
DOI: 10.4236/health.2013.51012   PDF    HTML   XML   3,757 Downloads   5,904 Views   Citations


Background: Headache is a common symptom and sometimes makes patients worry about stroke. Some stroke patients actually have headache. However, the frequency of headache at the onset of stroke and the relationship between headache and outcomes are not fully clarified. Objective: The aim of the study is to clarify frequency of headache, and to compare patients with headache with patients without headache in their characteristics, risk factors and early mortalities. Methods: We confirmed the presence or absence of onset headache in 1671 patients in the Kyoto Stroke Registry. We studied frequencies of headache, age, sex, blood pressure, arrhythmia, diabetes mellitus, hyperlipemia, tobacco and alcohol use and mortality of stroke patients. Results: Headache was observed in 21.4% of stroke patients; 12.0% in cerebral infarction (CI), 29.8% in cerebral hemorrhage (CH), and 93.9% in subarachnoid hemorrhage (SAH). Blood pressure at the first medical examination after stroke was higher in patients with headache. Factors associated with headache were age, diastolic blood pressure, hypertension and hyperlipemia histories, alcohol use, and paresis in CI, age, alcohol and tobacco use and paresis in CH and systolic blood pressure in SAH. The mortality rate 30 days after the stroke event was higher by 6.8% in CI and by 11.4% in CH in patients with headache than that in patients without headache. The hazard ratios for death between patients with headache and patients without headache were 4.94 (1.73 - 14.08, p = 0.003) in CI, and 3.20 (1.10 - 9.36, p = 0.033) in CH. Conclusions: Headache is common in stroke and predicts outcome. Headache is associated with younger age and alcohol use in CI and CH. Patients who could express presence of headache at the onset of CI or CH have higher mortality than patients who could express absence of headache. Headache is important both as an identifier of stroke and as a poor prognostic indicator in stroke.

Share and Cite:

Shigematsu, K. , Nakano, H. , Watanabe, Y. , Sekimoto, T. , Shimizu, K. , Nishizawa, A. , Okumura, A. , Makino, M. , Seki, T. , Bando, K. and Kitagawa, Y. (2013) Headache at the onset of stroke: Frequencies, background characteristics and correlation with mortality. Health, 5, 89-95. doi: 10.4236/health.2013.51012.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Balami, J.S., Chen, R.L., Grunwald, I.Q. and Buchan, A.M. (2011) Neurological complications of acute ischaemic stroke. Lancet Neurology, 10, 357-371. doi:10.1016/S1474-4422(10)70313-6
[2] Saita, M., Naito, T., Boku, S., Watanabe, Y., Suzuki, M., Oka, F., Takahashi, M., Sakurai, T., Sugihara, E., Haniu, T., Uehara, Y., Mitsuhashi, K., Fukuda, H., Isonuma, H., Lee, K. and Kobayashi, H. (2011) The efficacy of ma-huang-tang (maoto) against influenza. Health, 3, 300-303. doi:10.4236/health.2011.35052
[3] Gilbert, J.W., Johnson, K.M., Larkin, G.L. and Moore, C.L. (2012) Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology. Emergency Medicine Journal, 29, 576-581. doi:10.1136/emermed-2011-200088
[4] Weng, Y.M., Weng, T.C., Lee, W.J. and Lin, H.J. (2011) Intracranial hypotension: An unusual cause of headache in the emergency department. Emergency Medicine Journal, 28, 257-258. doi:10.1136/emj.2009.079186
[5] Jorgensen, H.S., Jespersen, H.F., Nakayama, H., Raas- chou, H.O. and Olsen, T.S. (1994) Headache in stroke: The Copenhagen Stroke Study. Neurology, 44, 1793-1797. doi:10.1212/WNL.44.10.1793
[6] Barnes, D.E., Mehta, K.M., Boscardin, W.J., Fortinsky, R.H., Palmer, R.M., Kirby, K.A. and Landefeld, C.S. (2012) Prediction of recovery, dependence or death in elders who become disabled during hospitalization. Journal of General Internal Medicine. doi:10.1007/s11606-012-2226-y
[7] Baron, J.C. (2011) Stroke: Predicting outcome after ischemic stroke-hard but achievable. Nature Reviews Neurology, 7, 253-254. doi:10.1038/nrneurol.2011.47
[8] Hermans, M.A., Leffers, P., Jansen, L.M., Keulemans, Y.C. and Stassen, P.M. (2012) The value of the Mortality in Emergency Department Sepsis (MEDS) score, C reactive protein and lactate in predicting 28-day mortality of sepsis in a Dutch emergency department. Emergency Medicine Journal, 29, 295-300. doi:10.1136/emj.2010.109090
[9] Wira III, C.R., Rivers, E., Martinez-Capolino, C., Silver, B., Iyer, G., Sherwin, R. and Lewandowski, C. (2011) Cardiac complications in acute ischemic stroke. Western Journal of Emergency Medicine, 12, 414-420. doi:10.5811/westjem.2011.2.1765
[10] Bourne, P.A. and McGrowder, D.A. (2010) Socio-demographic determinants of health status of elderly with self- reported diagnosed chronic medical conditions in Jamaica. Health, 2, 101-111. doi:10.4236/health.2010.22017
[11] Jo, S., Lee, J.B., Jin, Y.H., Jeong, T.O., Yoon, J.C., Jun, Y.K. and Park, B.Y. (2012) Moified early warning score with rapid lactate level in critically ill medical patients: The ViEWS-L score. Emergency Medicine Journal. doi:10.1136/emermed-2011-200760
[12] Shigematsu, K., Shimamura, O., Nakano, H., Watanabe, Y., Sekimoto, T., Shi-mizu, K., Nishizawa, A. and Makino, M. (2012) Vomiting should be a prompt predictor of stroke outcome. Emergency Medicine Journal. doi:10.1136/emermed-2012-201586
[13] Hatano, S. (1976) Experience from a multicentre stroke register: A preliminary report. Bulletin of the World Health Organization, 54, 541-553.
[14] Kumral, E., Bogousslavsky, J., Van Melle, G., Regli, F. and Pierre, P. (1995) Headache at stroke onset: The Lausanne Stroke Registry. Journal of Neurology, Neurosurgery & Psychiatry, 58, 490-492. doi:10.1136/jnnp.58.4.490
[15] Adams Jr., H.P., Jergenson, D.D., Kassell, N.F. and Sahs, A.L. (1980) Pitfalls in the recognition of subarachnoid hemorrhage. JAMA, 244, 794-796. doi:10.1001/jama.1980.03310080028019
[16] Naganuma, M., Fujioka, S., Inatomi, Y., Yonehara, T., Hashimoto, Y., Hirano, T. and Uchino, M. (2008) Clinical characteristics of subarachnoid hemorrhage with or without headache. Journal of Stroke and Cerebrovascular Diseases, 17, 334-339. doi:10.1016/j.jstrokecerebrovasdis.2008.04.009
[17] Kapral, M.K., Fang, J., Hill, M.D., Silver, F., Richards, J., Jaigobin, C., Cheung, A.M. and Investigators of the Registry of the Canadian Stroke N (2005) Sex differences in stroke care and outcomes: Results from the Registry of the Canadian Stroke Network. Stroke, 36, 809-814. doi:10.1161/01.STR.0000157662.09551.e5
[18] Arboix, A., Massons, J., Oliveres, M., Arribas, M.P. and Titus, F. (1994) Headache in acute cerebrovascular disease: A prospective clinical study in 240 patients. Cephalalgia, 14, 37-40. doi:10.1046/j.1468-2982.1994.1401037.x
[19] Mitsias, P.D., Ramadan, N.M., Levine, S.R., Schultz, L. and Welch, K.M. (2006) Factors determining headache at onset of acute ischemic stroke. Cephalalgia, 26, 150-157. doi:10.1111/j.1468-2982.2005.01012.x
[20] Vestergaard, K., Andersen, G., Nielsen, M.I. and Jensen, T.S. (1993) Headache in stroke. Stroke, 24, 1621-1624. doi:10.1161/01.STR.24.11.1621
[21] Friberg, L., Olesen, J., Iversen, H.K. and Sperling, B. (1991) Migraine pain associated with middle cerebral artery dilatation: Reversal by sumatriptan. Lancet, 338, 13- 17. doi:10.1016/0140-6736(91)90005-A
[22] Castillo, J., Martinez, F., Leira, R., Lema, M. and Noya, M. (1994) Plasma monoa-mines in tension-type headache. Headache, 34, 531-535. doi:10.1111/j.1526-4610.1994.hed3409531.x
[23] Lavados, P.M., Sacks, C., Prina, L., Escobar, A., Tossi, C., Araya, F., Feuerhake, W., Galvez, M., Salinas, R. and Alvarez, G. (2005) Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: A 2-year community-based prospective study (PISCIS project). Lancet, 365, 2206-2215. doi:10.1016/S0140-6736(05)66779-7
[24] Hacke, W., Schwab, S., Horn, M., Spranger, M., De Georgia, M. and von Kummer, R. (1996) “Malignant” middle cerebral artery territory infarction: Clinical course and prognostic signs. Archives of Neurology, 53, 309-315. doi:10.1001/archneur.1996.00550040037012
[25] Weimar, C., Mieck, T., Buchthal, J., Ehrenfeld, C.E., Schmid, E., Diener, H.C. and German Stroke Study C (2005) Neurologic worsening during the acute phase of ischemic stroke. Archives of Neurology, 62, 393-397. doi:10.1001/archneur.62.3.393
[26] Klatzo, I. (1985) Brain oedema following brain ischaemia and the influence of therapy. British Journal of Anaesthesia, 57, 18-22. doi:10.1093/bja/57.1.18
[27] Toldo, I., Cecchin, D., Sartori, S., Calderone, M., Mardari, R., Cattelan, F., Laverda, A.M., Drigo, P. and Battistella, P.A. (2011) Multimodal neuroimaging in a child with sporadic hemiplegic migraine: A contribution to understanding pathogenesis. Cephalalgia, 31, 751-756. doi:10.1177/0333102410392068
[28] Mullally, W.J. and Hall, K.E. (2010) Hypnic headache secondary to haemangioblastoma of the cerebellum. Cephalalgia, 30, 887-889. doi:10.1177/0333102409352911

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.