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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(09): 893-899
DOI: 10.1055/s-0042-1755269
Original Article

Characterization of persistent headache attributed to past stroke

Caracterização da cefaleia persistente atribuída a acidente vascular cerebral prévio
André Rêgo 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Rita Pinheiro 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Sofia Delgado 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Francisco Bernardo 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
,
Elsa Parreira 
1   Hospital Professor Doutor Fernando Fonseca, Serviço de Neurologia, Amadora, Lisboa, Portugal.
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Abstract

Background Persistent headache attributed to past stroke (PHAPS) is a controversial entity, recently included in the third edition of the International Classification of Headache Disorders (ICHD-3) despite being described only in retrospective studies.

Objective To determine the frequency and characteristics of PHAPS in patients admitted with acute stroke.

Methods We selected all patients with headache associated with acute stroke (HAAS) from a prospective, single-center registry of patients with acute stroke admitted to a Neurology ward between November 2018 and December 2019. We analyzed demographic, clinical, and neuroimaging data. We assessed the follow-up with a phone call questionnaire at 6 to 12 months.

Results Among 121 patients with acute stroke, only 29 (24.0%) had HAAS. From these, 6 (5.0%) were lost to follow-up. In total, 23 (20.0%) patients answered the 6- to 12-month follow-up questionnaire and were included in this study. The median age of the sample was 53 years (interquartile range [IQR]: 38–78 years), and there was no sex predominance. Of the 10 patients (8,3%) that had persistent headache, 8 (6.6%) suffered from previous chronic headaches; however, they all mentioned a different kind of headache, and 1 (0,8%) probably had headache secondary to medication.

Conclusions In the present study, only 10 out of 121 stroke patients (8.3%) referred persistent headache at the 6- to 12-month follow-up, but the majority already suffered from previous chronic headache, which raises the question that the actual prevalence of PHAPS may be lower than previously reported.

Resumo

Antecedentes A cefaleia persistente atribuída a acidente vascular cerebral (AVC) prévio é uma entidade controversa, recentemente incluída na terceira edição da Classificação Internacional de Transtornos da Cefaleia (International Classification of Headache Disorders, ICHD-3), apesar de descrita apenas em estudos restrospectivos.

Objetivo Determinar a frequência e as características do acidente vascular cerebral prèvio em doentes admitidos com AVC agudo.

Métodos Selecionamos todos os doentes com cefaleia associada a AVC agudo de um registro unicêntrico e prospectivo de doentes admitidos no serviço de Neurologia entre novembro de 2018 e dezembro de 2019. Analisamos dados demográficos, clínicos e imagiológicos. Reavaliamos aos 6 a 12 meses por questionário telefónico.

Resultados Entre os 121 doentes admitidos com AVC agudo, apenas 29 (24,0%) tinham cefaleia associada a AVC agudo. Destes, 6 (5,0%) perderam-se no seguimento. Ao todo, 23 (20,0%) responderam ao questionário e foram incluídos. A idade mediana foi de 53 anos (intervalo interquartílico [IIQ]: 38–78 anos), e não houve predominância de gênero. Dos 10 doentes (8,3%) que apresentam cefaleia persistente, 8 (6,6%) tinham histórico de cefaleia; no entanto todos mencionaram um tipo diferente de cefaleia, e 1 (0,8%) provavelmente tinha cefaleia secundária a medicação.

Conclusões Neste estudo, apenas 10 em 121 doentes (8,3%) mencionaram cefaleia persistente aos 6 a 12 meses de seguimento, mas a maioria sofria de cefaleia prévia, pelo que a real prevalência de acidente vascular cerebral prèvio pode ser inferior à descrita nos estudos realizados até a data.

Keywords

Vascular Headaches - Headache Disorders, Secondary

Palavras-chave

Cefaleias Vasculares - Transtornos da Cefaleia Secundários

Authors' Contributions

AR: writing the first draft of the manuscript; RP, SD: data collection; AR, FB: statistical analysis; and EP: supervision.




Publication History

Received: 07 July 2021

Accepted: 31 October 2021

Article published online:
09 November 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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