Headache attributed to transient ischemic attack: Assessment of its characteristics, associated factors and considerations on the diagnostic criteria

Background: Between 10 % and 36 % of patients with transient ischemic attack present with headache. Little is known regarding the characteristics of this headache.

Objectives: To assess the frequency of headache attributed to transient ischemic attack, its characteristics, and its associated factors, and whether the third edition of the International Classification of Headache Disorders criteria are adequate for diagnosing this headache.

Methods: This was a cross-sectional study that included patients consecutively admitted within 72 h of the onset of transient ischemic attack. A semi-structured questionnaire was used and all patients underwent magnetic resonance imaging.

Results: A total of 44 patients with a median age of 66 years (P_25- P₇₅: 59.5-77) were included in the study, of whom 55 % were male. The frequency of headache attributed to transient ischemic attack was 34.1 % (95 % CI: 20.5-49.9 %), and the most common characteristics were insidious onset (67 %), often after focal neurological symptoms (47 %), was bilateral (60 %), of moderate intensity, with a pattern similar to tension-type headache (67 %). One patient reported experiencing a thunderclap headache. Headache attributed to transient ischemic attack was not associated with any sociodemographic variables, any previous headaches, or the severity or etiology of transient ischemic attack. Only 13 % of patients with headache met the International Classification of Headache Disorders criteria for headache attributed to transient ischemic attack.

Conclusions: There is a high frequency of headache attributed to transient ischemic attack. The current diagnostic criteria for this headache are inadequate for its characteristics.