Headache often accompanies acute ischemic stroke. Observational studies indicate that 15% to 40% of patients with acute ischemic stroke report headache in close temporal relation to the event. The onset headache is more often seen in posterior circulation strokes than in strokes in other vascular territories. The pathophysiology of headache associated with acute ischemic stroke includes edema, hemorrhagic transformation, and changes in the trigeminovascular system.
• Headache is the leading symptom in subarachnoidal hemorrhage
• Headache is more frequent in ischemic stroke in the posterior circulation than in the anterior circulation
• Acute severe headache with neurologic signs requires cerebral imaging, or lumbar puncture, or both