Concomitant headache influences long-term prognosis after acute cerebral ischemia of noncardioembolic origin

Alberto Maino, Ale Algra, Peter J. Koudstaal, Erik W. Van Zwet, Michel D. Ferrari, Marieke J H Wermer

Research output: Contribution to journalArticle

Abstract

Background and Purpose - Acute cerebral ischemia is frequently associated with headache. It is unknown whether concomitant headache reflects a partly different pathogenesis, and thus, may influence long-term prognosis after stroke. Here, we compared the long-term risk of recurrent vascular events in patients in whom a transient ischemic attack or minor ischemic stroke of noncardioembolic origin was associated with headache with those without headache. Methods - We used data from the Life Long After Cerebral ischemia (LiLAC) cohort. Participants were grouped on the basis of presence or absence of headache at presentation. We calculated the hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for any first vascular event (primary outcome) or any cardiac or cerebral event (secondary outcomes). Adjustments were made for baseline clinical characteristics. Results - Of 2473 participants, 420 (17%) experienced headache during the acute event. Median follow-up was 14.1 years. For the primary outcome, the crude HR of headache versus no headache was 0.75 (95% CI, 0.66-0.89) and the adjusted HR 0.83 (95% CI, 0.71-0.97). For cardiac events the adjusted HR was 0.88 (95% CI, 0.67-1.14) and for cerebral events, 0.97 (95% CI, 0.76-1.24). The ratio of cardiac versus cerebral events, however, did not differ between the 2 groups. Participants with headache were at lower risk of vascular death (adjusted HR, 0.73; 95% CI, 0.61-0.87). Conclusions - Patients who experienced headache in association with a transient ischemic attack or minor ischemic stroke have a better vascular prognosis than those without concomitant headache. This may, at least partly, reflect a different pathogenesis.

Original languageEnglish
Pages (from-to)2446-2450
Number of pages5
JournalStroke
Volume44
Issue number9
DOIs
Publication statusPublished - Sep 2013

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Brain Ischemia
Headache
Confidence Intervals
Blood Vessels
Stroke
Transient Ischemic Attack

Keywords

  • Cohort studies
  • Headache
  • Headache disorders
  • Prognosis
  • Secondary
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialised Nursing

Cite this

Maino, A., Algra, A., Koudstaal, P. J., Van Zwet, E. W., Ferrari, M. D., & Wermer, M. J. H. (2013). Concomitant headache influences long-term prognosis after acute cerebral ischemia of noncardioembolic origin. Stroke, 44(9), 2446-2450. https://doi.org/10.1161/STROKEAHA.113.002217

Concomitant headache influences long-term prognosis after acute cerebral ischemia of noncardioembolic origin. / Maino, Alberto; Algra, Ale; Koudstaal, Peter J.; Van Zwet, Erik W.; Ferrari, Michel D.; Wermer, Marieke J H.

In: Stroke, Vol. 44, No. 9, 09.2013, p. 2446-2450.

Research output: Contribution to journalArticle

Maino, A, Algra, A, Koudstaal, PJ, Van Zwet, EW, Ferrari, MD & Wermer, MJH 2013, 'Concomitant headache influences long-term prognosis after acute cerebral ischemia of noncardioembolic origin', Stroke, vol. 44, no. 9, pp. 2446-2450. https://doi.org/10.1161/STROKEAHA.113.002217
Maino, Alberto ; Algra, Ale ; Koudstaal, Peter J. ; Van Zwet, Erik W. ; Ferrari, Michel D. ; Wermer, Marieke J H. / Concomitant headache influences long-term prognosis after acute cerebral ischemia of noncardioembolic origin. In: Stroke. 2013 ; Vol. 44, No. 9. pp. 2446-2450.
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abstract = "Background and Purpose - Acute cerebral ischemia is frequently associated with headache. It is unknown whether concomitant headache reflects a partly different pathogenesis, and thus, may influence long-term prognosis after stroke. Here, we compared the long-term risk of recurrent vascular events in patients in whom a transient ischemic attack or minor ischemic stroke of noncardioembolic origin was associated with headache with those without headache. Methods - We used data from the Life Long After Cerebral ischemia (LiLAC) cohort. Participants were grouped on the basis of presence or absence of headache at presentation. We calculated the hazard ratios (HRs) and corresponding 95{\%} confidence intervals (CI) for any first vascular event (primary outcome) or any cardiac or cerebral event (secondary outcomes). Adjustments were made for baseline clinical characteristics. Results - Of 2473 participants, 420 (17{\%}) experienced headache during the acute event. Median follow-up was 14.1 years. For the primary outcome, the crude HR of headache versus no headache was 0.75 (95{\%} CI, 0.66-0.89) and the adjusted HR 0.83 (95{\%} CI, 0.71-0.97). For cardiac events the adjusted HR was 0.88 (95{\%} CI, 0.67-1.14) and for cerebral events, 0.97 (95{\%} CI, 0.76-1.24). The ratio of cardiac versus cerebral events, however, did not differ between the 2 groups. Participants with headache were at lower risk of vascular death (adjusted HR, 0.73; 95{\%} CI, 0.61-0.87). Conclusions - Patients who experienced headache in association with a transient ischemic attack or minor ischemic stroke have a better vascular prognosis than those without concomitant headache. This may, at least partly, reflect a different pathogenesis.",
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AU - Algra, Ale

AU - Koudstaal, Peter J.

AU - Van Zwet, Erik W.

AU - Ferrari, Michel D.

AU - Wermer, Marieke J H

PY - 2013/9

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N2 - Background and Purpose - Acute cerebral ischemia is frequently associated with headache. It is unknown whether concomitant headache reflects a partly different pathogenesis, and thus, may influence long-term prognosis after stroke. Here, we compared the long-term risk of recurrent vascular events in patients in whom a transient ischemic attack or minor ischemic stroke of noncardioembolic origin was associated with headache with those without headache. Methods - We used data from the Life Long After Cerebral ischemia (LiLAC) cohort. Participants were grouped on the basis of presence or absence of headache at presentation. We calculated the hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for any first vascular event (primary outcome) or any cardiac or cerebral event (secondary outcomes). Adjustments were made for baseline clinical characteristics. Results - Of 2473 participants, 420 (17%) experienced headache during the acute event. Median follow-up was 14.1 years. For the primary outcome, the crude HR of headache versus no headache was 0.75 (95% CI, 0.66-0.89) and the adjusted HR 0.83 (95% CI, 0.71-0.97). For cardiac events the adjusted HR was 0.88 (95% CI, 0.67-1.14) and for cerebral events, 0.97 (95% CI, 0.76-1.24). The ratio of cardiac versus cerebral events, however, did not differ between the 2 groups. Participants with headache were at lower risk of vascular death (adjusted HR, 0.73; 95% CI, 0.61-0.87). Conclusions - Patients who experienced headache in association with a transient ischemic attack or minor ischemic stroke have a better vascular prognosis than those without concomitant headache. This may, at least partly, reflect a different pathogenesis.

AB - Background and Purpose - Acute cerebral ischemia is frequently associated with headache. It is unknown whether concomitant headache reflects a partly different pathogenesis, and thus, may influence long-term prognosis after stroke. Here, we compared the long-term risk of recurrent vascular events in patients in whom a transient ischemic attack or minor ischemic stroke of noncardioembolic origin was associated with headache with those without headache. Methods - We used data from the Life Long After Cerebral ischemia (LiLAC) cohort. Participants were grouped on the basis of presence or absence of headache at presentation. We calculated the hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for any first vascular event (primary outcome) or any cardiac or cerebral event (secondary outcomes). Adjustments were made for baseline clinical characteristics. Results - Of 2473 participants, 420 (17%) experienced headache during the acute event. Median follow-up was 14.1 years. For the primary outcome, the crude HR of headache versus no headache was 0.75 (95% CI, 0.66-0.89) and the adjusted HR 0.83 (95% CI, 0.71-0.97). For cardiac events the adjusted HR was 0.88 (95% CI, 0.67-1.14) and for cerebral events, 0.97 (95% CI, 0.76-1.24). The ratio of cardiac versus cerebral events, however, did not differ between the 2 groups. Participants with headache were at lower risk of vascular death (adjusted HR, 0.73; 95% CI, 0.61-0.87). Conclusions - Patients who experienced headache in association with a transient ischemic attack or minor ischemic stroke have a better vascular prognosis than those without concomitant headache. This may, at least partly, reflect a different pathogenesis.

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