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Association Between Migraine and Headache Attributed to Stroke: A Case–Control Study
Author(s) -
Nardi Katiuscia,
Parnetti Lucilla,
Pieri Maria L.,
Eusebi Paolo,
Calabresi Paolo,
Sarchielli Paola
Publication year - 2008
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/j.1526-4610.2008.01137.x
Subject(s) - migraine , medicine , stroke (engine) , ischemic stroke , infarction , cerebral infarction , cardiology , ischemia , anesthesia , pediatrics , myocardial infarction , mechanical engineering , engineering
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.