• Katiuscia Nardi, Lucilla Parnetti, Maria L Pieri, Paolo Eusebi, Paolo Calabresi, and Paola Sarchielli.
• Neurologic Clinic, Department of Medical and Surgical Specialties and Public Health, University of Perugia, Italy.
• Headache. 2008 Nov 1; 48 (10): 1468-75.

BackgroundSeveral studies were carried out to investigate the occurrence of headache attributed to acute stroke in patients with a lifetime history of migraine.MethodsIn a case-control series of 96 acute stroke patients with a lifetime history of migraine (M+) and 96 stroke patients without (M-), ischemic stroke patients only, without secondary infarction, were selected. The headache attributed to acute ischemic stroke was then analyzed.Results(M+) patients complained of headache more often than (M-) patients (P < .0001), mainly in the 24 hours before stroke onset (P < .0001). Migraine-like features of headache were recognized in a greater proportion of cases in the (M+) patient group with ischemic stroke (P < .018). A preferential brainstem location of ischemic stroke in (M+) patients emerged compared with (M-) patients (P = .014).DiscussionThe high prevalence of headache attributed to stroke in (M+) patients, in a relevant proportion of cases presenting as a sentinel headache, suggests that cerebral ischemia lowers the threshold for head pain more easily in these "susceptible" patients. The most frequent involvement of the brainstem in (M+) patients with ischemic infarction concurs with recent reports that emphasized a greater headache frequency when cerebral infarctions are localized in this structure or deep brain gray matter.

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