Tareq Kass-Hout, MD

Maino A,  Algra A, Koudstaal PJ, van Zwet EW, Ferrari MD, Wermer MJH. Concomitant Headache Influences Long-Term Prognosis After AcuteCerebral Ischemia of Noncardioembolic Origin. Stroke. 2013.

Maino et al. conducted a study, recently published online in stroke, to better evaluate the pathophysiology of acute cerebral ischemia that is associated with headaches. This study shed a light on a key question, as it is still unknown whether concomitant headache reflects a partly different pathogenesis and thus may influence long-term prognosis after Transient Ischemic Attack (TIA) or minor ischemic stroke of non-cardioembolic origin.

Patients in this retrospective study were recruited from LiLAC (Life Long After Cerebral ischemia) cohort. Participants were grouped based on the presence or absence of headache at presentation. Of 2473 participants, 420 (17%) experienced headache during the acute event. Participants with headache were at lower risk of any first vascular event or vascular death (HR 0.83; 95% CI 0.71-0.97 and adjusted HR 0.73; 95% CI 0.61- 0.87, respectively). The risk of any cardiac or cerebral event, however, did not differ between the two groups (HR 0.88; 95% CI 0.67-1.14 and 0.97; 95% CI 0.76-1.24).

In short, this study suggests that patients who experienced TIA or minor ischemic stroke in association with headaches have a better vascular prognosis than those without concomitant headache. This may, at least partly, reflect a different pathogenesis.