Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke
Abstract Background Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-co...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | The Journal of Headache and Pain |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10194-021-01372-x |
| _version_ | 1818332930578055168 |
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| author | Elena R. Lebedeva Anton V. Ushenin Natalia M. Gurary Denis V. Gilev Jes Olesen |
| author_facet | Elena R. Lebedeva Anton V. Ushenin Natalia M. Gurary Denis V. Gilev Jes Olesen |
| author_sort | Elena R. Lebedeva |
| collection | DOAJ |
| description | Abstract Background Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache. Methods This prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache. Results Our previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%. Conclusions We suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity. |
| first_indexed | 2024-12-13T13:43:34Z |
| format | Article |
| id | doaj.art-546cc3bf6099458d87b7c820d5f07225 |
| institution | Directory Open Access Journal |
| issn | 1129-2369 1129-2377 |
| language | English |
| last_indexed | 2024-12-13T13:43:34Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | The Journal of Headache and Pain |
| spelling | doaj.art-546cc3bf6099458d87b7c820d5f072252022-12-21T23:43:31ZengBMCThe Journal of Headache and Pain1129-23691129-23772022-01-012311810.1186/s10194-021-01372-xDiagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic strokeElena R. Lebedeva0Anton V. Ushenin1Natalia M. Gurary2Denis V. Gilev3Jes Olesen4Department of Neurology, the Ural State Medical UniversityDepartment of Neurology, the Ural State Medical UniversityMedical Union “New Hospital”Department of Economics, the Ural Federal UniversityDanishHeadache Center, Department of Neurology, Rigshospitalet-Glostrup, University of CopenhagenAbstract Background Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache. Methods This prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache. Results Our previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we developed diagnostic criteria for sentinel headache for the first time with a specificity of 98% and a sensitivity of 100%. Conclusions We suggest alternative diagnostic criteria for acute headache attributed to ischemic stroke and new diagnostic criteria for sentinel headache with high sensitivity and specificity.https://doi.org/10.1186/s10194-021-01372-xIschemic strokeHeadacheSecondary headacheHeadache attributed to ischemic strokeSentinel headacheHeadache in stroke |
| spellingShingle | Elena R. Lebedeva Anton V. Ushenin Natalia M. Gurary Denis V. Gilev Jes Olesen Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke The Journal of Headache and Pain Ischemic stroke Headache Secondary headache Headache attributed to ischemic stroke Sentinel headache Headache in stroke |
| title | Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke |
| title_full | Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke |
| title_fullStr | Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke |
| title_full_unstemmed | Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke |
| title_short | Diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke |
| title_sort | diagnostic criteria for acute headache attributed to ischemic stroke and for sentinel headache before ischemic stroke |
| topic | Ischemic stroke Headache Secondary headache Headache attributed to ischemic stroke Sentinel headache Headache in stroke |
| url | https://doi.org/10.1186/s10194-021-01372-x |
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