Prevalence and prognostic value of headache on early mortality in acute stroke: The Dijon Stroke Registry

Objective: To evaluate the prevalence of headache at onset and its association with 1-month mortality in stroke patients. Methods: All patients with stroke in Dijon, France (2006-2011), were prospectively identified using a population-based registry. Cox regression models were used to evaluate the association between headache and 30-day all-cause mortality. Results: Among 1411 stroke patients, data about headache were obtained for 1391 (98.6%) of whom 1185 had an ischemic stroke (IS), 201 had an intracerebral hemorrhage (ICH) and five had a stroke of undetermined etiology. Headache was found in 253 (18.2%) patients and was more frequent in those with ICH than in those with IS (46.3% vs 13.5%, p < 0.001). Overall 30-day mortality was 11.7%, and was greater for patients with than those without headache (17.0% vs 10.5%, unadjusted HR 1.70; 95% CI 1.20-2.41, p = 0.003). In multivariable analysis, an association between headache and 30-day mortality was observed (HR 1.51; 95% CI 1.02-2.25, p = 0.042). In stratified analyses, headache was associated with 30-day mortality in ICH (HR 2.09; 95% CI 1.18-3.71, p = 0.011) but not in IS (HR 1.01; 95% CI 0.53-1.92, p = 0.97). Conclusion: Headache at stroke onset is associated with a higher risk of early mortality in patients with ICH.