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Headache in acute cerebrovascular disease

Department of Neurology (Stroke Service) (Dr. Gorelick) and the School of Public Health (Epidemiology and Biometry Section) (Dr. Langenberg), University of Illinois, College of Medicine at Chicago, the Department of Neurology (Stroke Service) (Dr. Hier), Michael Reese Hospital and Medical Center. and the University of Chicago Prittker School of Medicine, Chicago, IL and the Department of Neurology (Stroke Service) (Dr. Caplan). New England Medical Center and Tufts University, Boston, MA.

Headache features were compared in 51 patients with acute subarachnoid hemorrhage (SAH), 61 with intraparenchymal hemorrhage (IPH), and 160 with ischemic stroke (IS). SAH patients had more sentinel headaches, more onset headaches, and more bilateral and severe onset headaches than patients with IPH or IS. Vomiting with onset headache was more common in SAH and IPH. In stepwise logistic regression analysis, onset headache and vomiting were direct predictors of SAH, but were inversely related to IS. Sentinel headache was not a predictor of underlying stroke mechanism. The data suggest that some headache features are more frequently associated with particular stroke subtypes and that onset headache and vomiting may be important indicators of stroke mechanism.

Address correspondence and reprint requests to Dr. Gorelick. Stroke Service, Michael Reese Hospital and Medical Center. Lake Shore Drive at 31st Street, Chicago, IL 60616.

Supported in part by the Amoco Foundation and NIH Contract #NOl-NS-2-2399.

Presented in part at the thirty-seventh annual meeting of the American Academy of Neurology. Dallas, TX. April 1985.

Accepted for publication March 10, 1986.

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