To determine whether the presence of headache acts as a prognostic factor in the clinical outcome of patients with AIS.

Headache as an initial symptom related to acute ischemic stroke (AIS) occurs in 8-34% of patients and is a little studied entity, so it is not known if this event is a prognostic factor.

Longitudinal study of the iReNe (i-Registro Neurovascular, iNeurovascular Registry) and First Mexican Registry of Headache (PREMECEF) registries from 2018 to 2022, with a diagnosis of AIS hospitalized in our hospital. Patients were divided into two groups, ACI with and without headache as initial symptom; the TOAST classification for etiology, NIHSS and modified Rankin scale (mRs) were used. 

We included 372 subjects, mean age 60.65±13.16 years, 61% men and 17.47% presented cerebral infarction with headache as part of the initial clinical syndrome, being the most common etiology, atherothrombotic (26%) and lacunar (20%). The most prevalent risk factors were hypertension (58%) and alcoholism (51%). A significant association was found between a better prognosis at hospital discharge in mRs and patients with AIS with headache (p=0.001), although there was no significant difference at 3 months (p=0.54). Likewise, a discrete association between AIS with low NIHSS and presentation with headache (p=0.05). Regarding the vascular territory affected, a significant association was found between the presence of headache and lenticulostriate arteries (p=0.043) and posterior cerebral artery (p=0.01).