| OBJECTIVE Headache,as a clinical symptom of intracranial vascular disease.It is mild,except for subarachnoid hemorrhage and intracerebral hemorrhage.It was often ignored because the lower disability and death.Recent studies have found that headache is not only a "sentinel" signal of acute ischemic stroke,but also associated with the prognosis of ischemic stroke.Then,for Chinese people,what are the characteristics of headache attributed to ischemic stroke ? and what are the factors associated with them? What is the role of headache in ischemic stroke? It’s still unknown.This study intends to summarize the clinical features and related factors of headaches.Idiopathic intracranial hypertension was dangerous.Over the past years,cranial venous sinus stenting has been extremely successful in this disease.In the third edition of the international headache classification,headac he attributable to cranial venous sinus stenting was proposed at first time.However,the reference of diagnostic criteria is less theoretical.The diagnostic criteria needs further verification and improvement.Now,to test the current diagnostic criteria for headache attributable to cranial venous sinus stenting and put forward suggestions for revision.We analyzed the patients who received cerebral venous sinus stenting in the past more than ten years in our hospital.To our knowledge,this study is the largest case series of headache attributable to cranial venous sinus stenting,with the longest duration of follow-up.METHODS:Part I The clinical characteristics of headache attributed to ischaemic strokeWe screened 576 patients with acute ischemic stroke in the First Medical Center of PLA General Hospital,between November 2016 and December 2021.Headache attributed to ischemic stroke,which were diagnosed according to the ICHD-3beta edition.At the end of the follow-up period,divide them into with and without headache.Data were analyzed with the aid of SPSS software v.25.0(IBM Corporation,Armonk,NY,USA).Chi-square(X2)test or Fisher’s exact test were used to compare and analyze the qualitative data,such as gender,migraine history,stenosis of the responsible artery(yes or not).Quantitative data,such as age,local cerebral blood flow,Tmax and reactive hyperemia index(RHI)were analyzed by T test or Mann-Whitney test.Logistic regression analysis was used to compare the location of intercerebral infarction and TOAST classification between the two groups.Part II Headache attributed to cranial venous sinus stentingFrom October 2010 to December 2021,we screened 74 patients with isolated pulsatile tinnitus(PT)due to intracranial venous sinus abnormality.From July 2004 to December 2021,a total of 121 patients with idiopathic intracranial hypertension(IIH)were include.All patients received intracranial venous sinus stenting.According to headache attributable to cranial venous sinus stenting in ICHD-3,they were divided into with and without headache separately.Data were analyzed with the aid of SPSS software v.25.0(IBM Corporation,Armonk,NY,USA).Chi-square(X2)test or Fisher’s exact test were used to compare and analyze the qualitative data,such as gender,location of pulpulsive tinnitus.Quantitative data,such as age,tinnitus duration and gradient pressure were analyzed by T test or Mann-Whitney test.RESULTSPart I The clinical characteristics of headache attributed to ischaemic strokeIn total our study included 576 patients with first ever ischemic stroke,12.7% of patients had headache.53 of them were males(72.6%).Their mean age was 56.8±26.2years.Headache at onset of ischemic stroke was present in 45(61.6%)cases.The whole head pain is common,moderate,non-throbbing pain and no other accompanying symptoms.The duration time was 0.5day-27 days.Age≤60 years,(P=0.000,OR=3.304,95%CI 1.739-5.293),History of migraine(P=0.023,OR=6.989,95%CI 1.310-37.283),heart disease(P=0.001,OR=2.987,95%CI 1.591-5.609),involvement of posterior circulation(P=0.001,OR=2.304,95%CI 1.380-3.846),largeartery atherosclerosis cerebral infarction(P=0.002,OR=1.976,95%CI 1.170-3.336)and bilateral transverse sinus symmetry(P=0.006,OR 7.147,95%CI 1.366-37.394)was significantly associated with headache attributed to ischaemic stroke.Subcortical infarcts,occipital lobe infarcts,medulla oblongata infarcts,cerebellar infarcts and multiple infarcts was also significantly associated with headache attributed to ischaemic stroke.Headache was not associated with prognosis of ischemic stroke in one month.There was no significantly difference in RHI between two groups.Part II Headache attributed to cranial venous sinus stenting74 isolated PT cases,the mean age at stent placement was 39.7±9.7 years.Females predominated(69,93.2%).The mean BMI was 24.0±3.2 kg/m2.The mean duration of symptoms prior to stenting was 4.4±4.5years.Headache attributed to cranial venous sinus stenting was observed in 18 patients(24.3%);such patients were younger than those without headache(34.3±9.1vs.41.4±9.3years of age).The headache was ipsilateral,oppressive,mainly occipital(61.6%)and located on the side of the stent.The headache generally began within 12 hours of recovery from general anesthesia,and lasted less than 3 days in 6 patients,(33.3%)3 days to 3 months in 7 patients(38.9%),and more than 3 months in 4 patients(22.3%).The onset age of pulsing tinnitus and pulsatile tinnitus side were significantly correlated with headache.However,there were no significant differences in BMI,lesion site,operation time and cerebral venous sinus stenosis(pressure difference)between two groups.121 IIH patients,females predominated(98,81%).The mean age at stent placement was 36.6±10.1 years.The mean BMI was 26.9±5.0 kg/m2.The mean duration of symptoms prior to stenting was 14.2±28.2years.Headache attributed to cranial venous sinus stenting was observed in 14 patients(11.6%).The headache was ipsilateral,oppressive,mainly occipital(50.5%)and located on the side of the stent.The headache generally began within 12 hours of recovery from general anesthesia,and lasted less than one week.There were no significant differences in sex,BMI,lesion site and cerebral venous sinus stenosis(pressure difference)between two groups.Conclusion: Part I The clinical characteristics of headache attributed to ischaemic strokeThis is the first prospective study on headache attributed to ischemic strok in Chinese people.Most patients had tension-type headache and the duration was less than 1 month.People who have migraine and have mild neurological deficits are more likely to have headaches.Posterior circulatory system involvement,atherosclerotic cerebral infarction,and bilateral transverse sinus symmetry were associated with ischemic stroke headache.However,headache did not predict 1-month outcome in stroke patients.When compared with the diagnostic criteria of ICHD-3,it was found that if the diagnostic criteria did not clearly define the relationship between the occurrence of stroke and the occurrence time of headache,the final study results might be affected.Part II Headache attributed to cranial venous sinus stentingFor the first time,isolated PT and IIH were analyzed separately in the current diagnostic criteria for Headache attributed to cranial venous sinus stenting.The headache was ipsilateral,oppressive,mainly occipital and located on the side of the stent.The headache generally began within 12 hours of recovery from general anesthesia,and mostly lasted less than 6 months.The incidence,location and duration of the headache were different from current diagnostic criteria.We believe that the diagnostic criteria of the International Classification of Headache Diseases(3rd edition)regarding headache due to cerebral venous sinus stenting need to be modified. |
PDF Full Text Request