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On Headache And Cerebrovascular Disease

N. Ramadan
Published 1994 · Medicine

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Headache is a common symptom of ischemic and hemorrhagic stroke (1, 2). In this issue of Cephalalgia, two studies of headache and cerebrovascular disease are reported (3, 4). Arboix et al. (3) present the results of a prospective study of the frequency and clinical characteristics of headache in stroke. The authors found that: (a) all patients with subarachnoid hemorrhage develop headache; (b) headache occurs more commonly with hemorrhagic than with ischemic stroke; (c) patients with ischemic stroke in the vertebrobasilar territory are more likely to complain of headache than patients with carotid territory stroke; and (d) the clinical characteristics of stroke-related headaches are variable and do not predict the mechanism or the location of the cerebral event. Similar conclusions have been reached in several other series (1, 2). In our Henry Ford Hospital Stroke Data Bank, the frequency of headache with ischemic stroke was 30%; vertebrobasilar territory strokes were more likely to cause headache than carotid territory strokes. It is intriguing that headache is a more consistent feature of vertebrobasilar than carotid territory strokes. Possibly, the former activates the trigemino-vascular system and thus causes headache more frequently. Arboix et al. (3) also found that headache accompanies "lacunar infarction" in 23% of patients, a surprisingly high rate when compared to the 3-17% range reported in other series (1, 2), including the most recent study from Denmark (5). As pointed out by Mitsias (1), the likely reason for this wide range is the different definitions of lacunar infarction used in each study. Furthermore, these findings suggest that cerebral ischemia in patients with headache and lacunar infarction are related to occlusion, partial or complete, of the proximal cerebral arteries instead of small vessel disease, since the intraparenchymal arterial penetrators are pain-insensitive.
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