LETTER TO THE EDITOR Association and American Stroke Asso- experts, and pain has been listed as 1 of Poststroke Headache: ciation, the word headache appeared 5 the 11 problems that are amendable to An Underdiagnosed Entity? times in the entire document in the con- treatment. However, most clinicians text of presenting symptoms of stroke may be more familiar with certain types and stroke deterioration. There was of poststroke pain such as central To the Editor: eadache is a well-known symptom no mention of poststroke headache in poststroke pain and other musculoskele- H associated with the onset of stroke. the stroke rehabilitation guideline from tal pain. Indeed, musculoskeletal pain is In the Copenhagen Stroke Study, 28% the American Heart Association and the most common type of pain in a 7 10 of patients had headache in relation to American Stroke Association. poststroke patient. This article serves stroke onset, particularly with intracerebral as a reminder that one should not negate There are no published guidelines hemorrhage and stroke in thevertebrobasilar poststroke headache as a type of pain for the management of poststroke head- territory. A recent study from Israel potentially confronting a stroke patient. ache to my knowledge. Poststroke head- with 2166 patients showed that 9.5% Rehabilitation physicians must ache was mentioned as a discrete entity of patients reported occurrence of head- better recognize the entity of poststroke in a comprehensive review on poststroke 2 8 ache in acute stroke. Fifty percent of headache, and more research is required pain by Harrison and Field with no spe- patients with sinus venous thrombosis, to improve our understanding and man- cific recommendation on management 21.3% of patients with intracerebral agement of poststroke headache. and that further study is needed. There hemorrhage, and 8.4% of patients with are 2 major limitations in the current lit- ischemic stroke reported headache. How- erature. First, making a clear diagnosis Tze Chao Wee, MBBS, ever, chronic headache as a long-term of headache attributed to ischemic stroke FAFRM(RACP), FFPMANZCA, sequela of stroke is less studied. or nontraumatic intracranial hemorrhage FAMS A 3-yr questionnaire-based follow-up based on the International Classification study examining the development of of Headache Disorders may be challeng- Department of Rehabilitation Medicine persistent headache after stroke showed ing. The temporal relationship of head- Changi General Hospital, Singapore that 12% (26/222) of the stroke patients ache with onset of stroke symptoms developed persistent new onset headache. may be difficult to know because some DOI: 10.1097/PHM.0000000000000835 A total of 7.2% (16/222) of the stroke patients may be drowsy in the initial patients had reported headache both at hours or days. On the other hand, question REFERENCES the stroke onset and at the 3-yr follow-up. remains when this new onset headache 1. Jørgensen HS, Jespersen HF, Nakayama H, et al: Of these 16 patients, approximately half crosses the threshold to be classified as a Headache in stroke: the Copenhagen Stroke Study. had tension-type–like headache and one primary headache. Second, even after a Neurology 1994;44:1793–7 third had migraine-like headache. A total diagnosis is made, there is no evidence- 2. Pollak L, Shlomo N, Korn Lubetzki I: National Acute of 62.5% of the patients reported a mod- Stroke Israeli Survey Group. Headache in stroke based recommendation made for the according to National Acute Stroke Israeli Survey. erate to severe pain intensity. Ten patients management of poststroke headache. Acta Neurol Scand 2017;135:469–75 had not reported headache at stroke Some practitioners may treat poststroke 3. Hansen AP, Marcussen NS, Klit H, et al: Development onset but reported new headache at the headaches by first characterizing the of persistent headache following stroke: a 3-year follow-up. Cephalalgia 2015;35:399–409 3-yr follow-up. headache as tension-type–like or mi- 4. Headache Classification Committee of the International Poststroke headache is a recog- graine-like headache and choose man- Headache Society (IHS): The International nized entity in the International Classi- agement options based on the evidence Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33:629–808 fication of Headache Disorders as a extrapolated from the management of 5. Bowen A, James M, Young G: National Clinical secondary headache under the sub- tension-type headache and migraine. Guideline for Stroke, Intercollegiate Stroke Working Party. heading of headache attributed to cranial/ As such, it is vital to note that some of 5th ed. 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In the British stroke Association/American Stroke Association. Stroke 2016;47:e98–169 of the headache, other treatments such guidelines, the word “headache” appeared 8. Harrison RA, Field TS: Post stroke pain: identification, as antidepressants, anticonvulsants, botu- 3 times in the entire document in the con- assessment, and therapy. Cerebrovasc Dis 2015;39:190–201 linum toxin, or occipital nerve block may text of a possible presenting symptom 9. Ward AB, Chen C, Norrving B, et al: Evaluation of the be considered in conjunction with psy- post stroke checklist: a pilot study in the United Kingdom of subarachnoid hemorrhage and cere- and Singapore. Int J Stroke 2014;9 suppl A100:76–84 chological and behavioral techniques. bral venous thrombosis. Similarly, in 10. Klit H, Finnerup NB, Jensen TS: Central post-stroke the guidelines for acute management of The poststroke checklist was devel- pain: clinical characteristics, pathophysiology, and ischemic stroke from the American Heart oped by an international group of stroke management. Lancet Neurol 2009;8:857–68 American Journal of Physical Medicine & Rehabilitation � Volume 00, Number 00, Month 2017 www.ajpmr.com 1 Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
American Journal of Physical Medicine & Rehabilitation – Wolters Kluwer Health
Published: Feb 1, 2017
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