image: Researchers classified the different types of headaches encountered by both groups during the year prior to arriving at an institution. learn more

Credit: UrFU / Polina Pogrebitskaya.

Researchers from Ural State Medical University, the Ural State Medical School and Ural State Medical University, Ural Federal University as well as University of Copenhagen. University of Copenhagen have developed new methods for diagnosing headaches that result from strokes caused by ischemic. It can help predict the onset, avoid, and promptly recognize and treat this deadly pathology promptly. The study’s description has been released by the journal Journal of Headache and Pain.

A stroke known as an Ischemic (or the brain’s infarction) occurs as a result of the heart, vascular or blood diseases, which are caused by an impaired circulation of the brain, which causes damage to the brain because of infarction development. It is among the most frequent causes of death and disability in human beings. The presence of a headache (in the initial instance in which the pain occurs 3-4 days prior to the stroke, this is known as a watchdog headache) could signal the impending or a stroke that is likely to occur. Thus, a precise assessment of the connection between stroke and headache is essential for its prevention and treatment.

The problem is that headache due to stroke is usually diagnosed through expert judgement using small samples of patients, rather than medical evidence gathered from extensive observational studies. The criteria for diagnosing sentinel headaches have not yet been established.

To identify specific, clinically validated symptoms of specific headaches that are that are a result of ischemic stroke researchers studied two categories of patients: those who had an initial stroke and those who do not suffer from any serious neurological disorder or diseases (stroke or brain tumors, epilepsy, trauma and other severe neurological and somatic disorders). The first group comprised 555 people. The second group, which was the control group comprised 192 patients.

The researchers classified the diverse headaches suffered by both groups prior to their the hospitalization, and also a week prior to the stroke and the day following the stroke. Three kinds of headaches were distinct: headaches that were common to those who suffer from them; headaches which have never before been experienced (new-type headaches) and headaches that had different characteristics (severe intensity high frequency, long duration, and then becoming pulsating. and accompanied by vomiting, nausea and a fear of light and sound and not responding well with analgesics).

New-type headaches and headaches that have distinct characteristics were prevalent in patients suffering from strokes: around 15% of these patients had headaches during the final week prior to the stroke, and another 15% reported headaches prior to the time of stroke’s onset.

“Patients who were in control groups were mainly admitted into the hospital emergency department due to pain-related disorders and, in the majority of cases, suffering from acute pain caused by pancreatitis or lumbago. It is widely known that these conditions may cause an increase in number of headaches, for example, as a result of frequent use of pain medication. However, research has not seen this phenomenon which suggests that the frequency of headaches in people suffering from stroke may be related with the stroke in itself. We derived this conclusion from the fact that the greater the number of headaches among patients in the general population differ from what is normal and the less time between the onset of pain and the beginning of the stroke the more likely it is that they have a causal link,” said head of the research group of professors in University of the Ural State Medical University Elena Lebedeva.

The findings of the research found that 55% of those who were examined in the first group had headaches that were new, while an additional 35% of them experienced familiar headaches, but with visible changes. However none of the participants in the group of control experienced unfamiliar headaches. Only two suffered from headaches with different symptoms upon being admitted to the hospital.

The results made it possible firstly to confirm the validity of the current guidelines for diagnosing headaches caused by stroke that are included within the International Classification of Headaches.

“It was discovered there was a 60% chance that headaches that occurred after stroke had the criteria for diagnosing stroke. This means that the criteria could require revision,” said associate professor at the Ural Federal University Denis Gilev.

2. Elena Lebedeva and another co-author Professor in Copenhagen University Jes Olesen, who was the creator of the International Classification of Headaches, updated the criteria for stroke-related headaches and created new criteria. First ever in the world they came up with criteria for the sentinel headache that, as research has revealed, predated the development of stroke in the case of one-third of patients.

“We created new and clear criteria that allow us to determine the nature of a headache in relation to the possibility of a stroke occurring or coming up. Our opinion is that each set of guidelines should be considered in the coming versions of the International Headache Classification,” concludes Elena Lebedeva.

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The type of headache is a good indicator of strokes that are ischemic.