Nav: Home

Headache far more common stroke symptom in children than adults

February 22, 2017

HOUSTON, Feb. 22, 2017 - Children are far more likely than adults to report headache when having a stroke, according to research presented at the American Stroke Association's International Stroke Conference 2017.

"Stroke should be considered as a possible diagnosis 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. Urgent brain imaging may be required to distinguish a migraine with aura from a stroke," said Lori L. Billinghurst, M.D., M.Sc., lead author of the study and clinical assistant professor of neurology at the University of Pennsylvania.

To examine how frequently headache occurs in childhood stroke, and whether headache pain is related to the reason for the stroke, researchers examined whether headache was documented at the onset of clot-caused (ischemic) stroke in 355 children (age 29 days to 18 years) enrolled in the multi-center Vascular Effects of Infection in Pediatric Stroke (VIPS) study funded by the National Institutes of Health.

Headache was reported in 6 percent of children under age 3 and 46 percent of those 3 or older - far higher than the estimated percent of adults who Billinghurst noted experience headache with an ischemic stroke.

Researchers note that the younger children may not have been able to communicate if they were having a headache.

Abnormalities in the blood vessel walls are a major reason for stroke in children, but the presence of headache did not distinguish between children with strokes related to artery abnormalities from others. In children 3 or older, researchers found headache was reported in:
  • 50 percent of children with definite artery abnormalities related ischemic stroke;

  • 3 percent of children with possible artery abnormalities related ischemic strokes;

  • 51 percent of children with no artery abnormalities related ischemic strokes.

However, of the 92 strokes in children with definite artery abnormalities related ischemic stroke, there were significant differences depending on the type of abnormality, with headache occurring 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. 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," Billinghurst said. "The VIPS study has already shown that inflammation plays a key role in the vascular injury pathway in children with stroke. 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 this study were too small to suggest that doctors use the presence of headache to determine the stroke cause, according to the researchers.

"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. We would like to develop a predictive formula that can help physicians diagnose stroke more rapidly and enable earlier, perhaps life-saving, stroke treatments," Billinghurst said.

The headache information in the study was limited to whether a doctor or parent reported that a child had a headache at the time of the stroke, so the researchers could not evaluate details such as when headache began, how long it lasted, how it was treated, or whether the child or family members were known to have had migraine headaches in the past.
-end-
Co-authors include Nancy K. Hills, Ph.D.; Laura Jastrzab, Ed.S.; Max Wintermark, M.D., M.A.S., M.B.A.; Gabrielle A. deVeber, M.D., M.H.Sc.; Heather J. Fullerton, M.D., M.A.S.; and Michael Dowling, M.D., Ph.D., for the VIPS Investigators. Author disclosures are on the abstract.

The VIPS study is funded by the National Institute of Neurological Disorders and Stroke.

Additional Resources: Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www.heart.org/corporatefunding.

Note: Actual presentation is 4:30 p.m. CT/5:30 p.m. ET, Thursday, Feb.23, 2017.

American Heart Association

Related Stroke Articles:

Retraining the brain to see after stroke
A new study out today in Neurology, provides the first evidence that rigorous visual training restores rudimentary sight in patients who went partially blind after suffering a stroke, while patients who did not train continued to get progressively worse.
Catheter ablations reduce risks of stroke in heart patients with stroke history, study finds
Atrial fibrillation patients with a prior history of stroke who undergo catheter ablation to treat the abnormal heart rhythm lower their long-term risk of a recurrent stroke by 50 percent, according to new research from the Intermountain Medical Center Heart Institute.
Imaging stroke risk in 4-D
A new MRI technique developed at Northwestern University detects blood flow velocity to identify who is most at risk for stroke, so they can be treated accordingly.
Biomarkers may help better predict who will have a stroke
People with high levels of four biomarkers in the blood may be more likely to develop a stroke than people with low levels of the biomarkers, according to a study published in the Aug.
Pre-stroke risk factors influence long-term future stroke, dementia risk
If you had heart disease risk factors, such as high blood pressure, before your first stoke, your risk of suffering subsequent strokes and dementia long after your initial stroke may be higher.
More Stroke News and Stroke Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...