The Interrelation between Chronic Headache, Cognitive Scores, and MRI Markers among Stroke Survivors

Jeremy Molad, Hen Hallevi, Amos D. Korczyn, Estelle Seyman, Natan M. Bornstein, Dana Niry, Roy Eldor, Einor Ben Assayag*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1555-1566
Number of pages12
JournalJournal of Alzheimer's Disease
Issue number4
StatePublished - 2021


  • Chronic headache
  • migraine
  • post-stoke cognitive impairment
  • stroke


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