Headaches far more common in kids than adults who have stroke

HOUSTON — Children are far more likely than adults to get headaches when having a stroke, a new study suggests.

The findings, presented Wednesday at the American Stroke Association's International Stroke Conference 2017, showed that 6 percent of children under age 3 and 46 percent of those 3 or older reported headaches — far higher than the estimated percent of adults who experience headache with an ischemic stroke.

“Stroke should be considered as a possible diagnosis(link opens in new window) in any child with a headache and additional symptoms of weakness or numbness (in the face, arm or leg) or changes in walking, talking or vision,” said Lori L. Billinghurst, M.D., M.Sc., clinical assistant professor of neurology at the University of Pennsylvania in Philadelphia. “Urgent brain imaging may be required to distinguish a migraine with aura from a stroke.”

Researchers examined whether headache was documented at the onset of clot-caused ischemic stroke in 355 children 29 days to 18 years old enrolled in the multi-center Vascular Effects of Infection in Pediatric Stroke. Younger children may not have been able to communicate if they were having a headache, researchers noted.

Abnormalities in the blood vessel walls are a major reason for stroke in children, but the presence of headache didn’t distinguish between children with strokes related to artery abnormalities from others.

Among children 3 years or older, 50 percent of those with definite artery abnormalities related ischemic stroke had headaches; 3 percent of those with possible artery abnormalities related ischemic stroke; and 51 percent with no artery abnormalities related ischemic stroke.

However, of the 92 strokes in children with definite artery abnormalities related ischemic stroke, there were significant differences depending on the type of abnormality. Headache occurred in 70 percent of children with stroke caused by a blood vessel tear (dissection); 70 percent of those with non-progressive narrowing of the blood vessels (transient arteriopathy of childhood); 12 percent of children with moyamoya disease, a rare cause of progressive blood vessel blockage at the base of the brain; and 43 percent of those with inflammation in blood vessel walls occurring after infection, cancer or other medical conditions.

“It is possible that younger brains have blood vessels that are more easily distended and more likely to activate pain sensors that trigger headache,” Billinghurst said. “It is also possible that inflammation — a powerful activator of pain sensors — may be more important in the processes underlying stroke in children than in adults.

“We will be doing further work to see if there are differences in blood markers of inflammation in those with and without headache at time of stroke.”

Although headache was most common in stroke related to blood vessel tears or narrowing, the numbers in the study were too small to suggest that doctors use the presence of headache to determine the stroke cause, Billinghurst said.

“We would like to conduct a study of children who enter hospital emergency rooms with headache and suspected stroke to see whether there are characteristics of the headache or other neurologic symptoms that predict whether a stroke will be confirmed on imaging,” she said. “We would like to develop a predictive formula that can help physicians diagnose stroke more rapidly and enable earlier, perhaps lifesaving stroke treatments.”