Translational Neurology Prospective Characterizations of Persistent Headache Attributed to Past Stroke

Background: Persistent Headache Attributed to Past Stroke (PHAPS) is a controversial entity, recently included in the new ICHD-3 classification despite being described only in retrospective studies. The aim of this study was to determine the incidence and characteristics of PHAPS in patients admitted with acute stroke. Methods: We selected all patients with Headache Associated with Acute Stroke (HAAS) from a prospective, single-centre registry of patients with acute stroke admitted to a Neurology ward between November 2018 and December 2019. We analysed demographic, clinical and neuroimaging data. We assessed the follow-up with a phone call questionnaire at 6-12 months. Findings: Among 121 patients with acute stroke, only 29 patients (24, 0%) had HAAS. From these, 6 were lost to follow-up. Twenty-three patients answered the 6 to 12- month follow-up questionnaire and were included in this study. Median age was 53 years (IIQ 38-78) and there was no gender predominance. Of the 10 patients (43, 5%) that had persistent headache, 8 clearly suffered from Previous Chronic Headaches (PCH), however, they all mentioned a different kind of headache. Only 1 patient did not have other reasons for a secondary headache. Conclusions: In this study, only 10 out of 121 stroke patients (8.3%) referred persistent headache at the 6 to 12-month follow-up, and the majority already suffered from PCH. In patients with PCH we observed a change of the usual headache pattern with even total remission. Only one (<0, 1%) patient with persistent headache at the 6 to 12-month follow-up did not have a clear PCH history.