Welcome to Stroke Education.CO.UK

Introduction

Headaches without any concerns of underlying brain pathology i.e. Primary headaches will rarely come to the attention of stroke physicians other than migraine. Migraine with aura is a common cause of associated headache with trainsent focal neurology and will be discussed below. Thunderclap headaches with sudden onset and intensity peaking wihtin 5 minutes should always raise the concern of SAH and these patients need an urgent CT head which is over 99% sensitive if done early. If there is a severe headache and lateralising neurology and no blood on CT then this is likely an ischaemic event. With modern scanners and early scanning CT is incredibly sensitive at diagnosing SAH. Occlusion of a large artery e.g. MCA will often cause an ipsilateral vascular type headache possibly due to increase collateral flow. These patients need urgent consideration for thrombolysis +/- Mechanical thrombectomy once a CT head has excluded any haemorrhage.

Headache commoner
  • Haemorrhagic > Ischaemic
  • Posterior > Anterior circulation infarcts
  • Thrombotic > embolic ischaemic strokes
  • Cortical > deep white matter strokes
  • Venous > arterial infarction

  • Top of Page