Thursday, June 13, 2019

Remote poststroke headache in children. Characteristics and association with stroke recurrence

Ana B. Chelse, Jonathan E. Kurz, Kathleen M. Gorman, Leon G. Epstein, Lauren C. Balmert, Jody D. Ciolino, Mark S. Wainwright.  Remote poststroke headache in children.  Characteristics and association with stroke recurrence.  Neurology Clinical Practice. 9(3):194-200, June 2019


Background New-onset headache after stroke is common among adult stroke survivors. However, pediatric data are limited. The primary aim of this study was to investigate the prevalence of new-headache after pediatric ischemic stroke. Secondary outcomes were to describe the characteristics of patients experiencing poststroke headache and the association between poststroke headache and stroke recurrence.

Methods We conducted a single-center retrospective study on children aged 30 days to 18 years with a confirmed radiographic diagnosis of arterial ischemic stroke (AIS) from January 1, 2008, to December 31, 2016. Patients were identified from an internal database, with additional data abstracted from the electronic medical record. Poststroke headache (occurring >30 days after stroke) was identified through electronic searches of the medical record and confirmed by chart review.

Results Of 115 patients with confirmed AIS, 41 (36%) experienced poststroke headache, with headache developing a median of 6 months after stroke. Fifty-one percent of patients with poststroke headache presented to the emergency department for headache evaluation; 81% of the patients had an inpatient admission for headache. Older age at stroke (odds ratio [OR] 21.5; p = 0.0001) and arteriopathy (OR 8.65; p = 0.0029) were associated with development of poststroke headache in a multivariable analysis. Seventeen patients (15%) had a recurrent stroke during the study period. Poststroke headache was associated with greater risk for stroke recurrence (p = 0.049).

Conclusions Remote poststroke headache is a common morbidity among pediatric stroke survivors, particularly in older children. Headaches may increase health care utilization, including neuroimaging and hospital admissions. We identified a possible association between poststroke headache and stroke recurrence.

A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence. Headache developed in over a third of participating children, on average six months after the stroke. Fifteen percent of patients suffered another stroke, typically in the first six to 12 months after the initial stroke. In the study, most children who experienced headache during stroke recurrence also had other associated neurologic symptoms, mostly weakness of one side of the body (hemiparesis) or facial asymmetry and brain malfunction (encephalopathy). Findings were published in Neurology: Clinical Practice, a journal of the American Academy of Neurology.

"In our study, post-stroke headache was more common in patients who experienced another stroke, which suggests that it might be a risk factor for stroke recurrence," says co-lead author Jonathan Kurz, MD, PhD, pediatric neurologist in the Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program at Ann & Robert H. Lurie Children's Hospital of Chicago, and Instructor of Pediatrics at Northwestern University Feinberg School of Medicine. "More research is needed to test this hypothesis, and it remains unclear if headache treatment would lower the risk for stroke recurrence. Children with post-stroke headache might need closer observation or different strategies to prevent another stroke. This requires more study."

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