Abstract WP049: Frequency and Severity of Headache in the Prehospital Setting in Acute Stroke

Introduction: Intracranial hemorrhage (ICH) may present with symptoms of headache, nausea, and vomiting with progressive worsening of neurological symptoms. Headache can sometimes be present at onset of stroke. However, most headache history is obtained after hospital arrival during emergency room evaluation, and after diagnostic studies are initiated. We present the feasibility and results of a brief headache-focused prehospital questionnaire administered in the ambulance. Methods: Data was collected during the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) clinical trial, a phase 3, NIH-NINDS-sponsored, randomized, placebo-controlled, clinical trial of magnesium sulfate in suspected hyperacute stroke < 2 hours of last known well time from onset of symptoms. The questionnaire was administered by physician investigators after study enrollment. The questionnaire included questions on the presence and severity of headache, and nausea as well as the presence of symptom progression. In cases where a subject could not provide consent due to aphasia or neglect, the questionnaire was not administered. Results: Subjects who consented to the study were administered a questionnaire about the presence and severity of headache by the investigator over the phone. A total of 485 consecutive subjects who were eligible for the survey were evaluated by paramedics within a median (IQR) of 24 (15-43.3) minutes after symptom onset. Headache was reported by 98 (19.6%) of the 485 recorded responses. Headache was reported as mild in 36 (37%) patients, medium in 49 (51%) patients, and severe in 10 (12%) patients. Headache was reported in 51 (39%) patients with ICH, 36 (11%) patients with final diagnosis of acute cerebral ischemia, and 8 (30%) patients with stroke mimics. Conclusion: Administering a simple 3-item questionnaire in the field was feasible. We found that 1 in 5 hyperacute stroke patients reported headaches within early hours from the last well known time and were able to describe the severity of the headache. A notable finding was that the symptoms of headache, nausea, and vomiting were more common among patients with patients diagnosed with ICH.