New Research: Headaches Much More Common in Pediatric Strokes than Adult Strokes

New research presented at the 2017 International Stroke Conference taking place in Houston, Texas confirms childhood strokes may be linked to headaches, much more often than in adults.

As reported by MedPage Today:

For children 3 to 18 years of age, 46% of acute arterial ischemic strokes presented with headache, Lori L. Billinghurst, MD, of the University of Pennsylvania in Philadelphia, and colleagues reported here at the International Stroke Conference.

While the rate was 6% in those younger than 3 years, limited communication capability may have limited reporting, Billinghurst noted at a press conference.

She contrasted the high rate of headache in the older children with the rate of no more than 25% among adults in a prior prospective hospital-based registry.

That’s almost two times the rate of headaches reported for children at or near the time of an ischemic stroke.  Given this new and critical finding, doctors need to pay attention.

Pediatricians and in particular emergency room doctors need to understand the difference in importance of headaches for children.  Otherwise, they may not recognize the emergency.  That will lead to more pediatric stroke malpractice for failure to diagnose.

“This study shows that headache at the time of stroke onset is more common in children than adults — in about 50% of cases,” Dr Saba told Medscape Medical News. “Stroke is much less common in children but still does occur; when it does occur, it is more likely to be attributed to an abnormality of the blood vessels.”

How should doctors react?  As reported in EMS World, this requires doctors to take action:

“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,” 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.”

That is not to say headache alone is enough to diagnose stroke in children.  It is just a factor to consider in a differential diagnosis.

Why do children suffering from stroke have (or report) more headaches than adults?  According to one of the study’s lead authors, the issue may related to the differences in juvenile brain blood vessels, or the role of inflammation:

“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.

See the American Heart Association’s press release for more information on the report.

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