Headache before stroke more common in migraineurs

NEW YORK (Reuters Health) - A new study of stroke patients indicates that those with migraine are much more likely to experience a headache prior to the onset of stroke than are similar stroke patients with no history of migraine or serious headaches, Italian researchers report in the current issue of the journal Headache.

As senior investigator Dr. Paola Sarchielli told Reuters Health, “Headache is a common clinical symptom preceding or accompanying stroke, and migraine patients have a greater probability of complaining of headache, often with migraine-like features, before and during acute stroke than non-migraineur patients.”

Sarchielli of the University of Perugia and colleagues also note that there are limited data available on the characteristics of headaches associated with ischemic stroke and their relationship to the symptoms and neuroimaging evidence seen in patients with a history of migraine.

To further investigate, the researchers analyzed data from 146 ischemic stroke patients, 70 of whom had a lifetime history of migraine and 76 who did not. Ischemic stroke, the most common type of stroke, is the result of a blockage of a vessel in the brain. The blockage cuts of the supply of blood and, subsequently, the supply of oxygen to surrounding brain tissue, which begins to died, a process referred to as ischemia.

Nearly 80 percent of the migraine patients had a headache in the 24 hours before their stroke or at its onset, compared with 20 percent of those without migraine.

This “suggests that cerebral ischemia lowers the threshold for head pain more easily in these ’susceptible’ patients,” the researchers point out.

The researchers also found the ischemic area was located in the brainstem in 16 percent of the migraine group, significantly more often than the 4 percent seen in the control group. Brainstem strokes are the most devastating because this area of the brain controls involuntary life-support functions such as breathing, blood pressure and heart rate.

“The more frequent involvement of brainstem in migraineur patients with ischemic infarction supports the hypothesis that vascular events preceding the clinical stroke…can cause a dysfunction of this structure, which may be more predisposed to be abnormally activated,” concluded Sarchielli.

SOURCE: Headache, November/December 2008.

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