Sentinel headache as a warning symptom of ischemic stroke

Background: There are no previous controlled studies of sentinel headache in ischemic stroke. The purpose of the present study was to evaluate the presence of such headache, its characteristics and possible risk factors as compared to a simultaneous control group. Methods: Eligible patients (n = 550) had first-ever acute ischemic stroke with presence of new infarction on magnetic resonance imaging with diffusion-weighted imaging (n = 469) or on computed tomography (n = 81). As a control group we studied in parallel patients (n = 192) who were admitted to the emergency room without acute neurological deficits or serious neurological or somatic disorders. Consecutive patients with stroke and a simultaneous control group were extensively interviewed soon after admission using validated neurologist conducted semi-structured interview forms. Based on our previous study of sentinel headache in transient ischemic attacks we defined sentinel headache as a new type of headache or a previous kind of headache with altered characteristics (severe intensity, increased frequency, absence of effect of drugs) within seven days before stroke. Results: Among 550 patients with stroke 94 patients (17.1%) had headache during seven days before stroke and 12 (6.2%) controls (p < 0.001; OR 3.9; 95% CI 1.7-5.8). Totally 81 patients (14.7%) had sentinel headache within the last week before stroke and one control. Attacks of arrythmia during seven days before stroke were significantly associated with sentinel headache (p = 0.04, OR 2.3; 95% CI 1.1-4.8). Conclusions: A new type of headache and a previous kind of headache with altered characteristics during one week before stroke are significantly more prevalent than in controls. These headaches represent sentinel headaches. Sudden onset of such headaches should alarm about stroke. © 2020 The Author(s)

Migraine before rupture of intracranial aneurysms

BACKGROUND: Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA. METHODS: In a prospective case–control study 199 consecutive patients with SIA (103 females and 96 males, mean age: 43.2 years) received a semistructured face to face interview focusing on past headaches. All were admitted to hospital mostly because of rupture (177) or for unruptured aneurysm (22). In parallel we interviewed 194 blood donors (86 females, 108 males, mean age: 38.4 years). Diagnoses were made according to the International Headache Society criteria. Aneurysms were diagnosed by conventional cerebral angiography. RESULTS: During the year before rupture, 124 (62.3%) had one or more types of headache. These headaches included: migraine without aura (MO): 78 (39.2%), migraine with aura (MA): 2 (1%), probable migraine (PM): 4 (2%), tension-type headache (TTH): 39 (19.6%), cluster headache (CH): 2 (1%), posttraumatic headaches (PH): 2 (1%). 1-year prevalence of headaches in controls was 32.5% (63 patients out of 194), they included: TTH: 45 (23.1%), MO: 17(8.8%), PH: 1(0.5%). Only the prevalence of MO was significantly higher in patients with SIA (OR 6.7, 95% CI 3.8-11.9, p < 0.0001). CONCLUSIONS: Unruptured SIA cause a marked increase in the prevalence of migraine without aura but not in the prevalence of other types of headache

Persistent headache after first-ever ischemic stroke: clinical characteristics and factors associated with its development

Background: It is poorly described how often headache attributed to stroke continues for more than 3 months, i.e. fulfils the criteria for persistent headache attributed to ischemic stroke. Our aims were: 1) to determine the incidence of persistent headache attributed to past first-ever ischemic stroke (International headache society categories 6.1.1.2); 2) to describe their characteristics and acute treatment; 3) to analyse the prevalence of medication overuse headache in patients with persistent headache after stroke; 4) to evaluate factors associated with the development of persistent headache after stroke. Methods: The study population consisted of 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke, among them 529 patients were followed up at least three months after stroke. Standardized semi-structured interview forms were used to evaluate these headaches during professional face-to-face interviews at stroke onset and telephone interviews at 3 months. Results: At three months, 61 patients (30 women and 31 men, the mean age 60.0) of 529 (11.5%) follow-up patients had a headache after stroke: 34 had a new type of headache, 21 had a headache with altered characteristics and 6 patients had a headache without any changes. Therefore 55 (10.4%) patients had a persistent headache attributed to ischemic stroke. Their clinical features included: less severity of accompanying symptoms, slowly decreasing frequency and development of medication overuse headache in one-third of the patients. The following factors were associated with these headaches: lack of sleep (29.1%, p = 0.009; OR 2.3; 95% CI 1.2–4.3), infarct in cerebellum (18.2%, p = 0.003; OR 3.0; 95% CI 1.4–6.6), stroke of undetermined etiology (50.9%, p = 0.003; OR 2.3; 95% CI 1.3–4.1), less than 8 points by NIHSS score (90.9%, p = 0.007; OR 3.4; 95% CI 1.4–8.6) and low prevalence of large-artery atherosclerosis (12.7%, p = 0.006; OR 0.3; 95% CI 0.2–0.80). Conclusion: Persistent headache attributed to ischemic stroke is not rare and frequently leads to medication overuse. The problem is often neglected because of other serious consequences of stroke but actually, it has a considerable impact on quality of life. It should be a focus of interest in the follow-up of stroke patients. © 2022, The Author(s).We thank Tatiana S. Tsypushkina and Polina A. Philimonova for the help with data collection. None

Diagnostic Criteria for Acute Headache Attributed to Ischemic Stroke and for Sentinel Headache Before Ischemic Stroke

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. © 2022, The Author(s)

New alternative diagnostic criteria for migraine with aura and migraine with typical aura and their prospective testing in patients with transient ischemic attacks in comparison to main body criteria

Introduction: The International Classification of Headache Disorders 3rd edition beta (ICHD-3 beta) gave alternative diagnostic criteria for 1.2 migraine with aura (MA) and 1.2.1 migraine with typical aura (MTA) in the appendix. The latter were presumed to better differentiate transient ischemic attacks (TIA) from MA. The aim of the present study was to field test that. Methods: A neurologist interviewed soon after admission 120 consecutive patients diagnosed with TIA after MRI or CT. Semistructured interview forms addressed all details of the TIA episode and all information necessary to apply the ICHD-3beta diagnostic criteria for 1.2,1.2.1, A1.2 and A1.2.1. Results: Requiring at least one identical previous attack, the main body and the appendix criteria performed almost equally well. But requiring only one attack, more than a quarter of TIA patients also fulfilled the main body criteria for 1.2. Specificity was as follows for one attack: 1.2:0.73, A1.2:0.91,1.2.1:0.88 and A1.2.1:1.0. Conclusion: The appendix criteria performed much better than the main body criteria for 1.2 MA and 1.2.1 MTA when diagnosing one attack (probable MA). We recommend that the appendix criteria should replace the main body criteria in the ICHD-3.В настоящее время используются основные критерии мигрени с аурой. Но в приложении к 3 изданию международной классификации головной боли (МКГБ-3 бета, 2013) представлены также альтернативные диагностические критерии 1.2 мигрени с аурой и 1.2.1 мигрени с типичной аурой, которые могли бы позволить лучше отличать мигрень с аурой от транзиторной ишемической атаки (ТИА), однако их тестирования у больных с ТИА не производилось. Цель настоящего исследования состояла в том, чтобы протестировать эти критерии у больных с ТИА, чтобы выявить, насколько они являются подходящими для лучшего отличия мигрени с аурой от ТИА. Методы: 120 пациентов с диагнозом ТИА после магнитно-резонансной (МРТ, п=112) или компьютерной томографии (КТ, п=8) были опрошены неврологом с использованием полуструктурированного интервью для уточнения клинических деталей эпизода ТИА и всей информации, необходимой для диагностики мигрени с аурой согласно критериям МГКБ-3 бета для 1.2 мигрени с аурой, А1.2 мигрени с аурой (альтернативные критерии), 1.2.1 мигрени с типичной аурой и А1.2.1 мигрени с типичной аурой (альтернативные критерии). Результаты: Если в анамнезе уже был по крайней мере один такой же эпизод, как основные, так и альтернативные, одинаково хорошо подходили для дифференциального диагноза ТИА и мигрени с аурой. Но в случае наличия только одного первого эпизода у четверти пациентов с ТИА имелось соответствие клинических проявлений основным критериям для 1.2 мигрени с аурой, что затрудняло дифференциальный диагноз. При этом специфичность альтернативных критериев была намного выше, чем основных критериев как для мигрени с аурой, так и для мигрени с типичной аурой. Специфичность основных и альтернативных критериев для одного эпизода распределилась следующим образом: 1.2 мигрень с аурой (основные критерии): 0.73, А1.2 мигрень с аурой (альтернативные критерии): 0.91,1.2.1 мигрени с типичной аурой: 0,88 и А1.2.1 мигрени с типичной аурой (альтернативные критерии): 1.0. Выводы: Альтернативные критерии мигрени с аурой и мигрени с типичной аурой позволяют намного лучше отличить мигрень от ТИА, чем основные критерии при диагностике только одного эпизода. Их нужно использовать в клинической практике

Specific features of Bazhenov suite sediments in south-eastern Nurolsk sedimentary basin (Tomsk Oblast)

The specific sediment features in Georgiev (J[3]kmgr), Bazhenov (J3vbg) and Kulomzin (K1bkl) suites, exposed by drilling in the S-E Nurolsk depression (Tomsk Oblast), were defined and described via petrographic, X-ray diffraction and fluorescence-microscopy analysis methods. The classification of agrillites was identified, the structure-texture features, composition, voids and bitumen types and their distribution were determined. It was defined that Bazhenov suite argillites are characteristic of fine-dispersion, high biogenic silica content and scattered organic matter, enriched multi-composite syngenetic bitumen (from light to resin-asphaltine), as well as fractured surface where the migration of light bitumen occurs