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

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

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

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Koudstaal, Peter J. Ferrari, Michel D. Wermer, Marieke J. H. Algra, Ale Maino, Alberto Van Zwet, Erik W.
Description	Country affiliation: Italy Author Affiliation: Maino A ( Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Università degli Studi di Milano, Milan, Italy.)
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.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	9
Volume Number	44
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2013-09-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Brain Ischemia Epidemiology Headache Complications Stroke Acute Disease Mortality Comorbidity Heart Diseases Ischemic Attack, Transient Prognosis Time Factors Comparative Study Research Support, Non-u.s. Gov't Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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