Clinical study of headache in brain stem infarction

Abstract

The clinical findings of headache asstociated with brain stem infarction were evaluated in 53 cases including, 28 with pontine infarction and 25 with medullary infarction. Headache occurred in 17 patients (31%), including 5 with pontine infarction (18%) and 12 with medullary infarction (48%). It was significantly more common in medullary infarction than in pontine infarction (p<0.05). The headache was bioccipital and mild in all of the 5 cases with pontine infarction. In contrast, it was lateralized at the ipsilateral side of the lesion in all of the 12 cases with medullary infarction: 8 cases (66%) had headache in the frontal lobe and 6 cases (50%) in the occipital lobe. Among the 12 cases of medullary infarction, the headache was severe in 4, moderate in 4, and mild in the remaining 4 cases. Headache preceded the onset of stroke by 2 to 14 days in 4 (33%) of the 12 patients with medullary infarction. Angiography revealed a dissecting aneurysm of the posterior inferior cerebellar artery (PICA) in one patient with medullary infarction. It is suggested that the mechanism of headache in medullary infarction differed from that in pontine infarction. We infer that headache with medullary infarction may be caused mainly by a dissecting aneurysm of the vertebral artery or PICA.