Prevalence of headache and its association with depression in chronic stroke patients

Abstract

　Background: Persistent or aggravated headache after stroke is not uncommon, but its clinical significance and impact on quality of life remain unclear. We investigated the prevalence and characteristics of headache in chronic stroke patients and its association with depressive status.
　Methods: We retrospectively enrolled 142 outpatients with chronic stroke (>3 months after onset) . Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) , and headache impact was evaluated using the Headache Impact Test-6 (HIT-6) . “Post-stroke headache” was defined as either newly developed headache after stroke or worsening/change of pre-existing headache after stroke. Clinical characteristics, stroke subtype/location, modified Rankin Scale, Clinical Frailty Scale (CFS) , pain symptoms, and medication use were analyzed.
　Results: Headache was present in 30 patients (21.1%) , and 22 (15.5%) met the definition of post-stroke headache. Patients with post-stroke headache more frequently had posterior circulation stroke (59.1% vs. 27.5%, P＝0.006) , higher PHQ-9 scores, and more concomitant pain/numbness symptoms. HIT-6 scores positively correlated with PHQ-9 scores (p＝0.538, P＝0.002) . Depressive status (PHQ-9≥5) was observed in 58 patients (40.8%) . Multivariable logistic regression analysis demonstrated that CFS (OR 1.86, 95% CI 1.44–2.46, P<0.001) and post-stroke headache (OR 8.71, 95% CI 2.93–30.43, P<0.001) were independently associated with depressive status.
　Conclusions: Post-stroke headache was observed in approximately 15% of chronic stroke patients and was associated with posterior circulation lesions and depressive status independently of physical disability. Comprehensive assessment including headache and psychological symptoms may be important in chronic stroke care.