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June 2019; 9 (3) Research

Remote poststroke headache in children

Characteristics and association with stroke recurrence

Ana B. Chelse, Jonathan E. Kurz, Kathleen M. Gorman, Leon G. Epstein, Lauren C. Balmert, Jody D. Ciolino, Mark S. Wainwright
First published May 17, 2019, DOI: https://doi.org/10.1212/CPJ.0000000000000652
Ana B. Chelse
From the Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
MD, MS
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Jonathan E. Kurz
From the Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
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Kathleen M. Gorman
From the Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
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Leon G. Epstein
From the Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
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Lauren C. Balmert
From the Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
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Jody D. Ciolino
From the Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
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Mark S. Wainwright
From the Department of Pediatrics (ABC, JEK, LGE), Division of Neurology, Northwestern University Feinberg School of Medicine; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (JEK, KMG), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Department of Preventive Medicine (LCB, JDC), Northwestern University Feinberg School of Medicine, Chicago, IL; and Division of Pediatric Neurology (MSW), University of Washington Medical School, Seattle.
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Citation
Remote poststroke headache in children
Characteristics and association with stroke recurrence
Ana B. Chelse, Jonathan E. Kurz, Kathleen M. Gorman, Leon G. Epstein, Lauren C. Balmert, Jody D. Ciolino, Mark S. Wainwright
Neurol Clin Pract Jun 2019, 9 (3) 194-200; DOI: 10.1212/CPJ.0000000000000652

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Abstract

Background New-onset headache after stroke is common among adult stroke survivors. However, pediatric data are limited. The primary aim of this study was to investigate the prevalence of new-headache after pediatric ischemic stroke. Secondary outcomes were to describe the characteristics of patients experiencing poststroke headache and the association between poststroke headache and stroke recurrence.

Methods We conducted a single-center retrospective study on children aged 30 days to 18 years with a confirmed radiographic diagnosis of arterial ischemic stroke (AIS) from January 1, 2008, to December 31, 2016. Patients were identified from an internal database, with additional data abstracted from the electronic medical record. Poststroke headache (occurring >30 days after stroke) was identified through electronic searches of the medical record and confirmed by chart review.

Results Of 115 patients with confirmed AIS, 41 (36%) experienced poststroke headache, with headache developing a median of 6 months after stroke. Fifty-one percent of patients with poststroke headache presented to the emergency department for headache evaluation; 81% of the patients had an inpatient admission for headache. Older age at stroke (odds ratio [OR] 21.5; p = 0.0001) and arteriopathy (OR 8.65; p = 0.0029) were associated with development of poststroke headache in a multivariable analysis. Seventeen patients (15%) had a recurrent stroke during the study period. Poststroke headache was associated with greater risk for stroke recurrence (p = 0.049).

Conclusions Remote poststroke headache is a common morbidity among pediatric stroke survivors, particularly in older children. Headaches may increase health care utilization, including neuroimaging and hospital admissions. We identified a possible association between poststroke headache and stroke recurrence.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • ↵* These authors contributed equally to the manuscript.

  • Received September 10, 2018.
  • Accepted March 28, 2019.
  • © 2019 American Academy of Neurology
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