The Interrelation Between Chronic Headache, Cognitive Scores, and MRI Markers Among Stroke Survivors

Article type: Research Article

Authors: Molad, Jeremy^a | Hallevi, Hen^{a; b} | Korczyn, Amos D.^b | Seyman, Estelle^a | Bornstein, Natan M.^c | Niry, Dana^d | Eldor, Roy^{b; e} | Ben Assayag, Einor^{a; b; *}

Affiliations: [a] Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel | [b] Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel | [c] Department of Neurology, Shaare-Zedek Medical Center, Jerusalem, Israel | [d] Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel | [e] Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel

Correspondence: [*] Correspondence to: Einor Ben Assayag, PhD, Department of Neurology, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel. E-mail: [email protected].

Abstract: Background:Migraine is known to mildly increase the risk for ischemic stroke and is associated with vascular MRI markers. However, the potential effect of chronic headache (CH) on stroke outcomes has not been studied. Objective:We aimed to assess the interrelation between CH and post-stroke cognitive impairment. Methods:Data from 455 patients with a first ever stroke from the TABASCO study was available. All patients underwent 3T brain MRI, blood analysis, and a serial cognitive assessment at baseline and 6, 12, and 24 months after. Results:Eighty-five (18.7%) patients reported suffering from CH, of whom 53 (62.4%) reported symptoms of photophobia or nausea, and 34 (40%) reported an aura. CH was associated with female sex, lower prevalence of T2DM (p < 0.001), and lower HbA1C levels (p < 0.001). Multiple regression analysis, controlling for age, sex, education, vascular risk factors, and the presence of acute lesions in MRI, revealed that CH was an independent predictor of better cognitive scores 6, 12, and 24 months post-stroke (p = 0.015, p = 0.01, and p = 0.012, respectively). Stroke patients suffering from CH had also higher normalized gray, white matter, and thalamus volumes, and better white matter microstructural integrity (p < 0.001, p = 0.037, p < 0.001, p = 0.008, respectively) Conclusion:In this study, CH was consistently associated with better long term cognitive scores among post stroke subjects. These surprising findings may partially arise from the higher prevalence of T2DM among subjects without CH, that may represent the existence of chronic cerebrovascular disease, and may reflect mechanisms involving glucose metabolism.

Keywords: Chronic headache, migraine, post-stoke cognitive impairment, stroke, TABASCO

DOI: 10.3233/JAD-210077

Journal: Journal of Alzheimer's Disease, vol. 81, no. 4, pp. 1555-1566, 2021