This article is more than 5 years old. Information may no longer be current.
Children more likely to experience headache during stroke than adults
Click Here to Manage Email Alerts
Children were more likely to report headache at time of stroke compared with adults, according to data presented at the International Stroke Conference.
According to the presentation from Lori L. Billlinghurst, MD, MSc, pediatric neurologist at the Children’s Hospital of Philadelphia and professor of neurology at the University of Pennsylvania, nearly half of all children aged over 3 years experienced headaches at the time of stroke.
“Pediatric stroke is rare, affecting approximately 2 to 13 per 100,000 children per year and finding a child and diagnosing a child in an [ED] with stroke, many times is like identifying a needle in a haystack,” Billinghurst said in a presentation. “We know, in the pediatric stroke world that headache is common, but nobody has really studied this well, looked at the actual prevalence, nor studied any of the actual relationships to other features of the stroke presentation or the underlying reasons for the stroke.”
The Vascular Effects of Infection in Pediatric Stroke (VIPS) study enrolled children aged 29 days to 18 years into a prospective, international study to be analyzed for the occurrence of headache at stroke ictus.
Patients were put through a rigorous, centralized process to confirm acute ischemic stroke and radiographic classification of arteriopathy diagnosis as either definite, possible or absent.
Using medical records relating to stroke presentation details, researchers classified headache at time of stroke as present, absent or unclear.
Secondary analysis included all cases from the VIPS study (n = 355).
While headache was present in only 6% of patients aged younger than 3 years (5 of 90), it was present in 46% (108 of 265) of patients aged 3 years and older, a higher rate than reported in adults with stroke, according to a press release.
In children aged 3 years or older, headache at stroke ictus was not significantly different for those with definite (50%), possible (63%) or absent (51%) arteriopathy (p = .53). There was, however, a significant difference found among patients with definite arteriopathy. For these patients, headache was more common in transient cerebral arteriopathy of childhood and dissection, occurring in 70% of both sets of patients (P > .001). Headaches were more common in children with strokes in the right hemisphere and in the distribution of the posterior circulation, specifically posterior cerebral artery and superior cerebellar artery.
“The takeaway points for physicians are that stroke should really be on the differential diagnosis for any child presenting with headache and new-onset symptoms,” Billinghurst said. “They should really consider these children for rapid neuroimaging so that children who have stroke can be diagnosed and considered for hyper-acute therapies like [tissue plasminogen activator] and mechanical thrombectomy.” – by Dave Quaile
Reference:
Billinghurst LL, et al. Abstract 174. Presented at: International Stroke Conference; Feb. 22-24, 2017; Houston, TX.
Disclosure: Billinghurst reports no relevant financial disclosures.