Headache Prevalence in Pediatric Ischemic Stroke

Headaches may more commonly be associated with stroke in children younger than 18 years than in adults, according to a study presented at the International Stroke Conference taking place February 22 to 24, 2017, in Houston, Texas.¹

The study, “Headache Presentation in Childhood Arterial Ischemic Stroke Differs by Arteriopathy Subtype,” was conducted by researchers from several institutions in the United States and Canada and sought to determine whether children presenting with arteriopathy-related strokes were more likely to experience headaches at stroke onset than those without.

Previous prospective studies showed high prevalence of headache at stroke onset in adult patients, thus implicating headaches in the etiology of the phenomenon.^2,3 The investigators of the present study hypothesized that children presenting with strokes resulting from arteriopathies may display higher rates of headaches than healthy children.

After diagnostic confirmation of arterial ischemic stroke and classification of arteriopathy, presence of headache at stroke ictus was examined in children aged 29 days to 18 years (n = 355) who were enrolled in the National Institutes of Health-funded Vascular Effects of Infection in Pediatric Stroke (VIPS) study. Although only 6% of study participants younger than 3 years presented with headaches, 46% of those older than 3 years presented with headaches. Presence or absence of arteriopathy did not affect occurrence of headache at stroke ictus in children older than 3 years (P =.53).

The majority of children diagnosed with definite arteriopathy and presenting with dissection and transient cerebral arteriopathy of childhood had headache complaints (70%, P <.001). The researchers conclude that this finding “may reflect a higher degree of nociceptive afferent activation in these childhood [arterial ischemic stroke] subtypes and may provide clues to underlying pathophysiologic mechanisms.”

In a news release, study lead author Lori Billinghurst, MD, a clinical assistant professor of neurology at the University of Pennsylvania, Philadelphia, added: “Stroke should be considered as a possible diagnosis in any child with a headache and additional symptoms of weakness or numbness (in the face, arm, or leg) or changes in walking, talking, or vision. Urgent brain imaging may be required to distinguish a migraine with aura from a stroke.”⁴

Dr Billinghurst hypothesized that this high prevalence of headaches in children may be a result of the distinct physiology of their vascular system compared with that of adults: “It is possible that younger brains have blood vessels that are more easily distended and more likely to activate pain sensors that trigger headache. It is also possible that inflammation — a powerful activator of pain sensors — may be more important in the processes underlying stroke in children than in adults.”⁴

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References

1. Billinghurst LL, Hills NK, Jastrzab L, Wintermark M, deVeber GA, Fullerton HJ, Dowling M. Headache Presentation in childhood arterial ischemic stroke differs by arteriopathy subtype. Presented at: International Stroke Conference; February 22-24, 2017; Houston, TX.
2. Paciaroni M, Parnetti L, Sarchielli P, Gallai V. Headache associated with acute ischemic stroke. J Headache Pain. 2001;2(1):25-29. doi: 10.1007/s101940170043
3. Tentschert S, Wimmer R, Greisenegger S, Lang W, Lalouschek W. Headache at stroke onset in 2196 patients with ischemic stroke or transient ischemic attack. Stroke. 2005;36(2):e1-3. doi: 10.1161/01.STR.0000151360.03567.2b
4. Headache far more common stroke symptom in children than adults [news release]. Houston, TX: American Stroke Association newsroom; February 22, 2017. http://newsroom.heart.org/news/headache-far-more-common-stroke-symptom-in-children-than-adults. Accessed February 22, 2017.