So, you described something and incompetently provided NO EXACT NEXT STEPS TO SOLVE THE PROBLEM! In the business world that would be grounds for immediate firing. Aren't you glad you're in the absolutely incompetent stroke medical world?
Nearly half of patients with hemorrhagic stroke experience headache
Key takeaways:
- The systematic review included 24 studies and 4,688 adults with hemorrhagic stroke.
- There were no significant associations between headache and diabetes mellitus, hypertension, alcoholism or previous headache.
Nearly half of all patients with hemorrhagic stroke also experience headache across its acute and chronic phases that could contribute to long-term morbidity, according to a review published in Headache.
Yet the prevalence of headache varied substantially across populations and clinical settings, Bradley Ong, MD, adult neurology resident at Neurological Institute, Cleveland Clinic, and colleagues wrote.
“In clinical practice, headaches after hemorrhagic stroke came up quite often in our clinical practice, but they were rarely addressed,” Ong told Healio.
Most treatment after stroke focuses on motor recovery and preventing its recurrence, he said, with headache treated as an incidental or transient symptom.
“When we looked at the literature, there was no clear, consolidated picture of how common these headaches are or how long they last,” Ong said. “That gap is what motivated this study.”
Ong and colleagues conducted a systematic review and meta-analysis that included 24 peer-reviewed, observational studies from Medline, Embase and CENTRAL with 4,688 adults (mean age, 56.9 years; weighted mean, 58.2% women) with hemorrhagic stroke.
“The most striking finding was how common headaches are,” Ong said. “Nearly half of patients with hemorrhagic stroke experience headache, and more than one-third go on to have persistent headaches months or years later.”
Overall, 46.1% (95% CI, 36.3% to 56.1%) of these patients experienced headache after their stroke. Eleven studies (n = 2,481) found that 55.9% of patients (95% CI, 41.1% to 70.1%) experienced acute headache. Thirteen studies (n = 2,207) found that 36.7% of patients (95% CI, 25.6% to 48.5%) had persistent headache.
“This challenges the assumption that headache is mainly an ‘acute’ symptom, especially in hemorrhagic stroke,” Ong said.
Specific prevalences of headache included 58.3% (95% CI, 44.4% to 71.6%) for those with subarachnoid hemorrhage (SAH) and 36.1% (95% CI, 26.7% to 46%) for those with intracerebral hemorrhage (ICH).
Prevalence of severe headaches included 42.7% (95% CI, 15.8% to 72.1%) among those whose headaches were acute/subacute and 14.3% (95% CI, 10.4% to 18.7%) among those whose headaches were persistent.
With an overall I2 of 96.7%, the researchers said their findings indicated substantial heterogeneity in these pooled prevalence estimates, with no statistically significant differences based on study design, population, geography, Human Developmental Index or risk for bias.
Further, Ong and colleagues said there were no significant associations between risk for headache and female sex, nor were there any significant associations with history of diabetes mellitus, hypertension, alcoholism or previous headache.
“Another important finding was that headache at stroke onset strongly predicted chronic headache, which gives us an early clinical signal we can actually act on,” Ong said.
The odds ratio for post-stroke headache among patients with headache at stroke onset was 1.7 (OR = 1.7; 95% CI, 1.4-2.05). Also, the odds ratio for post-stroke headache among patients with lobar ICH was 1.93 (95% CI, 1.08-3.44).
There were no significant associations between headache risk and cortical ICH or delayed cerebral ischemia. Also, there were no significant associations between headache risk and the presence of an anterior circulation aneurysm among patients with SAH.
Patients with atrial fibrillation had less risk for headache (OR = 0.59; 95% CI, 0.37-0.95), which the researchers attributed to differences in stroke severity and symptom reporting and not to any direct protective effect.
Noting that the prevalence of headache among patients with hemorrhagic stroke exceeds the prevalence of other primary headache disorders among the general population, with substantial variations by population and clinical settings, the researchers called these headaches “common” as well as “persistent and disabling.”
Ong said that clinicians can use these findings to improve outcomes for patients with stroke.
“Clinicians should ask about headache routinely, both in the hospital and during follow-up. Headache should be treated as a meaningful post-stroke complication,” he said.
“Patients who report headache early may benefit from closer monitoring and earlier referral to headache care,” he continued. “Even simple steps like education and avoiding unnecessary opioid exposure can improve quality of life.
Looking ahead, the researchers called for studies with standardized diagnostic criteria, clearly defined populations and detailed headache characteristics into protective therapies and secondary prevention strategies.
“The next step is prospective, longitudinal studies using standardized headache definitions and patient-reported outcomes,” Ong said.
“We also need clinical trials focused specifically on post-stroke headache treatment, rather than extrapolating from primary headache disorders,” he added. “Ultimately, the goal is to integrate headache care into routine stroke recovery.”
For more information:
Bradley Ong, MD, can be reached at ongb@ccf.org.
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