老年缺血性中风相关性头痛的特征及影响因素

The Analysis of Characteristics and Associated Factors of Headache Symptoms in the Senior Patients with Acute Ischemic Stroke

目的:在急性中风病人中,头痛是常见的症状,但是缺血性中风起病初期头痛的发病机制尚有许多争议,有必要深入探讨头痛临床特征及相关影响因素。方法:选择2003-10～2009-01住院确诊的急性缺血性中风316例(脑梗死270例,TIA46例),其中81例有起病时的头痛,回顾性分析这些病人的年龄、性别、既往病史、入院就诊时的血压、可能的病因、病灶的位置、中风严重程度的相关因素。结果:81例(26%)病人在缺血性中风起病时出现头痛。中风相关性头痛似乎与性别、先前的偏头痛病史、年轻化、小脑中风以及入院时的血压偏低有关,而与中风的严重性、可能的病因无关。结论:①急性脑血管病病人头痛与可能的病因、预后无关;②椎基底动脉系统中风相关性头痛发生率高,主要与小脑中风相关;③缺血性中风相关性头痛可能与病人年轻化、先前的偏头痛病史、入院时的血压有关。因此,在诊治头痛病人时,需要详细的病史询问、细致的体格检查,关注局灶神经体征,不要误诊为复杂偏头痛发作而忽略后循环缺血性中风。

Objective：Headache is a common symptom in acute stroke.It is necessary to analyze the characteristics of headache symptoms at ischemic stroke onset but many aspects of its association with other clinical factors are controversial.Methods：We analyzed characteristics of headache symptoms at ischemic stroke onset and associations between headache at stroke onset and at several clinical parameters in 316 cases experiencing ischemic stroke or transient ischemic attack at admission.Results：81 cases （26%） experienced headache at stroke onset.Headache at stroke onset was positively associated with female sex,history of migraine,younger age,cerebellar stroke and blood pressure values on admission 110 mmHg systolic and 70 mmHg diastolic.It showed no significant association with stroke severity measured by the modified NIHSS at days 5 to 7 after the event,presumed etiology.Conclusions：Our results show no association of headache with stroke etiology or outcome.Our results indicate that the previously described association of headache with vertebrobasilar stroke is mainly because of its association with cerebellar stroke.We can confirm previously described associations of headache at stroke onset with younger age and a history of migraine,implicating a careful evaluation of young patients with a focal neurological deficit and a history of migraine to avoid misclassification as complicated migraine.