Thrombolysis increases the risk of persistent headache attributed to ischemic stroke: A prospective observational study

Author:

Zhang Yi1ORCID,Qu Wensheng12,Ayata Cenk34,Kong Qianqian1,Zhao Jing1,Zhou Xirui1,He Dan5,Yu Zhiyuan12,Huang Hao12,Luo Xiang12ORCID

Affiliation:

1. Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China

2. Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China

3. Department of Radiology, Massachusetts General Hospital Harvard Medical School Charlestown Massachusetts USA

4. Department of Neurology, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA

5. Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital Sun Yat‐sen University Guangzhou China

Abstract

AbstractBackground and objectivePersistent headache attributed to ischemic stroke (PHPIS) is increasingly acknowledged and was added to the 2018 ICHD‐3. Intravenous thrombolysis (IVT) is a common treatment for acute ischemic stroke. It remains unknown whether this treatment influences the occurrence of a persistent poststroke headache. We aimed to describe the incidence and clinical characteristics of persistent headaches occurring after acute ischemic stroke in patients with or without IVT and explore the risk factors.MethodsA prospective observational study was performed between the 234 individuals who received IVT and 226 individuals without IVT in 5 stroke units from Wuhan, China. Subjects were followed for 6 months after stroke via a structured questionnaire.ResultsAge, gender, vascular risk factors, and infarct location/ circulation distribution did not differ between the groups, although IVT group had higher initial NIHSS scores. At the end of the follow‐up, 12.0% (55/460) of subjects reported persistent headaches after ischemic stroke. The prevalence of persistent headache was significantly higher in the IVT group than non‐IVT group (15.4% vs. 8.4%, p = .021). Patients with younger age (= .033; OR 0.97; 95% CI 0.939–0.997), female sex (= .007; OR 2.40; 95% CI 1.269–4.520), posterior circulation infarct (= .024; OR 2.19; 95% CI 1.110–4.311), and IVT (= .005; OR 2.51; 95% CI 1.313–4.782) were more likely to develop persistent headache after ischemic stroke.ConclusionThe potential influence of IVT should be considered when assessing persistent poststroke headache. Future studies will investigate the underlying mechanisms.

Funder

National Natural Science Foundation of China

Publisher

Wiley

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