TOPLINE:

Headaches occurred in about 46% of patients with hemorrhagic stroke in a new meta-analysis, with a higher prevalence among those with subarachnoid hemorrhage (SAH) than among those with intracerebral hemorrhage (ICH). Additionally, more than half of the participants experienced acute headaches and more than one third developed headaches that persisted beyond 3 months.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 24 observational studies that investigated the prevalence of headaches after hemorrhagic stroke in nearly 5000 patients with hemorrhagic stroke (mean age, 57 years; 58% female).
• Acute or subacute headache was defined as onset within 3 months of stroke, persistent as lasting more than 3 months, and severe as ≥ 7 of 10 paint intensity or functional impairment.
• Primary outcomes were the pooled prevalence of headache after hemorrhagic stroke and factors associated with its occurrence. Secondary outcomes included differences in prevalence of headache by stroke subtype, headache type (acute or subacute vs chronic), and patient comorbidities.
• Subgroup analyses were conducted on the basis of stroke subtype, sex, comorbidities, and quality assessment measures used.

TAKEAWAY:

• The overall pooled prevalence of headache following hemorrhagic stroke was 46% (95% CI, 36%-56%).
• The pooled prevalence of headache was 58% (95% CI, 44%-72%) following SAH and 36% (95% CI, 27%-46%) following ICH. Headaches frequently became chronic following both conditions.
• Acute or subacute headache occurred in 56% (95% CI, 41%-70%) of patients, whereas persistent headache occurred in 37% (95% CI, 26%-48.5%). Severe headache was reported by 43% (95% CI, 16%-72%) of patients with acute/subacute headaches and by 14% (95% CI, 10%-19%) of those with persistent headaches.
• Among patients with ICH, lobar ICH was significantly associated with increased risk for persistent headaches after hemorrhagic stroke (odds ratio [OR], 1.9; P = .03). Atrial fibrillation was associated with lower odds of poststroke headache (OR, 0.6; P = .03). No significant associations with headache were found for women vs men or for those with diabetes, hypertension, or a history of alcoholism or prior headaches.

IN PRACTICE:

“Headache is a common but understudied condition that can manifest at or soon after a hemorrhagic stroke and can persist for years, potentially contributing to long-term morbidity,” the investigators of the study wrote.

“Standardized headache definitions and longitudinal assessments are needed to improve recognition and inform future clinical trials targeting this underappreciated source of poststroke morbidity,” they added.

SOURCE:

The study was led by Bradley Ong, MD, Neurological Institute, Cleveland Clinic, Cleveland. It was published online on December 02 in Headache.

LIMITATIONS:

Several included studies did not use standardized diagnostic criteria for poststroke headaches, contributing to heterogeneity in results. Most studies did not account for preexisting primary headache disorders, potentially introducing misclassification bias. The reliance on retrospective chart reviews in many cases increased the risk for information bias, particularly underreporting mild or transient headache symptoms. Several studies excluded patients with severe stroke syndromes, impaired consciousness, or aphasia, which may have potentially resulted in selection bias and an underestimation of headache prevalence.

DISCLOSURES:

One investigator reported serving as an editorial board member for the Neurology Resident & Fellow Section and the Journal of Central Nervous System Disease and declared attending Axsome Therapeutics-sponsored educational dinners. The other researchers reported having no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.