Abnormalities in the blood vessel walls are a major reason for
stroke in children. Children are far more likely than adults to report headache when
having a stroke, according to research presented at the American Stroke
Association's International Stroke Conference 2017.
"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. Urgent
brain imaging may be required to distinguish a migraine with aura from a
stroke," said Lori L. Billinghurst, lead author of the
study and clinical assistant professor of neurology at the University of
‘Headache was reported in 6% of children under age three and 46% of those three or older - far higher than the estimated percent of adults who experience headache with an ischemic stroke.’
To examine how frequently headache occurs in childhood stroke, and
whether headache pain is related to the reason for the stroke,
researchers examined whether headache was documented at the onset of
clot-caused (ischemic) stroke in 355 children (age 29 days to 18 years)
enrolled in the multi-center Vascular Effects of Infection in Pediatric
Stroke (VIPS) study funded by the National Institutes of Health.
Headache was reported in 6% of children under age three and 46% of those three or older - far higher than the estimated percent of
adults who Billinghurst noted experience headache with an ischemic
Researchers note that the younger children may not have been able to communicate if they were having a headache.
In children three or older, researchers found headache was reported
- 50% of children with definite artery abnormalities related ischemic stroke;
- 3% of children with possible artery abnormalities related ischemic strokes;
- 51% of children with no artery abnormalities related ischemic strokes.
However, of the 92 strokes in children with definite artery
abnormalities related ischemic stroke, there were significant
differences depending on the type of abnormality, with headache
- 70% of children with stroke caused by a blood vessel tear (dissection);
- 70% of those with non-progressive narrowing of the blood vessels (transient arteriopathy of childhood);
- 12% of children with moyamoya disease, a rare cause of progressive blood vessel blockage at the base of the brain; and
- 43% of those with inflammation in blood vessel walls occurring after infection, cancer, or other medical conditions.
"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.
The headache information in the study was limited to whether a
doctor or parent reported that a child had a headache at the time of the
stroke, so the researchers could not evaluate details such as when
headache began, how long it lasted, how it was treated, or whether the
child or family members were known to have had migraine headaches in the