ATLANTA—Chronic headache in men may predict an increased risk for stroke, reported researchers from the National Public Health Institute, Helsinki, at the 72nd Scientific Sessions of the American Heart Association. Specific links between migraine and stroke have been suggested in a number of previous studies, said Pekka Jousilahti, MD, in an interview; in fact, a close temporal association has been observed in some cases, he said. The aim of the current study was to explore the possibility of a similar link between chronic, nonspecific headache and the risk of stroke.

A cohort of 35,077 middle-aged Finnish men and women were followed for five years. At baseline, 9% of the men and 17% of the women reported frequent headaches, meeting study criteria for the chronic headache group. Participants reporting headaches "sometimes" or "never" were combined in a comparison group, explained Dr. Jousilahti.

Although chronic headache was nearly twice as common among the women, men appeared to have a higher related risk of stroke, Dr. Jousilahti and colleagues found. During the follow-up period, men with chronic headache were nearly twice as likely to have a fatal or nonfatal stroke than men without chronic headache.

The respective headache-associated risk ratios (chronic headache versus no chronic headache) for ischemic, hemorrhagic, and total stroke were 1.90, 1.96, and 1.86. Risk ratios related to headache fell only slightly after adjustment for smoking, cholesterol, and systolic blood pressure, reported Dr. Jousilahti.

Risk ratios were highest among younger men with chronic headache. In the 25 to 49 age-group, the risk ratio was 2.36, falling to 1.60 in the 50 to 64 age-group. The headache-associated risk of stroke was higher among smokers (2.01) than among nonsmokers (1.39).

Among women in the study, a weaker—nonsignificant—link was seen between chronic headache and stroke. With increasing duration of follow-up, the headache/stroke link declined in both men and women. Since women at baseline were twice as likely to report frequent headaches, Dr. Jousilahti speculated that etiologic factors may differ in men and women. Further study is warranted, he added.

These preliminary findings should be interpreted with caution, Dr. Jousilahti emphasized. "I don't want to get people worried that if they have headache, they might have the risk for a stroke, because that is not [necessarily] true," he said. Clinical implications for health professionals, however, might include devoting extra attention to stroke risk factors—such as smoking and hypertension—in patients who report chronic headaches that have no obvious cause.

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