The overall incidence of headache was 75% (52/69) in this cohort. In the headache group (n = 52), 55.8% (29/52) of the patients were females. The median age was 37 years [IQR 27–45 years]. Among these patients, 28 (51.9%) had exploding headache; 15 (28.8%) had migraine‑like headache; 3 (5.7%) had chronic tension headache 3; 6 (11.54%) had other types of headache. In the non-headache group (n = 17), 5 (29%) of the patients were females. The median age of patients without headache was 50 years [IQR 38–67 years] (Table 1).
Table 1
Demographic and clinical characteristics of patients at admission
| Headache groups n = 52 | Non-headache groups n = 17 | X2/Z-value | P-value |
Gender(male/female) | 23/29 | 12/5 | 4.947 | 0.025 |
Age( years ) | 37(27,45) | 50(38,67) | -2.862 | 0.004 |
Subgroups Acute stage Subacute stage Chronic stage | 28 (53.84%) 15 (28.85%) 9 (17.31%) | 11 (64.70%) 5 (29.41%) 1 (9.09%) | 1.423 | 0.0491 |
DSA | 3(1,4) | 3(1,3) | -0.732 | 0.670 |
SBP (mmHg) | 121(112,131) | 129(120,141) | -1.928 | 0.054 |
DBP (mmHg) | 74(67,80) | 78.5(69,89.75) | -1.132 | 0.258 |
WBC (× 109/L) | 7.33(5.78,8.92) | 8.05(6.49,11.06) | -1.436 | 0.151 |
L(×109/L) | 1.7(1.09,2.08) | 1.39(1.05,2.24) | -0.555 | 0.579 |
LR(%) | 0.25(0.172,0.327) | 0.18(0.14,0.236) | -2.076 | 0.038 |
MCV(ng/L) | 88.10 (84,91) | 90.4(88.65,92.40) | -2.112 | 0.035 |
USG | 1.014 (1.010,1.020) | 1.013(1.010,1.015) | -0.993 | 0.479 |
HBs-Ab (ug/ml) | 24.03(24.03,154.54) | 28.07(5.97,154.56) | -0.271 | 0.787 |
BUN (mg/L) | 3.5(2.80,4.15) | 4.75(3.90,6.00) | -3.052 | 0.002 |
ICP (mm H2O) | 234 (200,290) | 200(171.25,234) | -2.237 | 0.025 |
Protein (CSF) (g/L) | 0.55(0.284,0.605) | 0.605(0.605,0.995) | -3.103 | 0.002 |
ADA (CSF) (U/L) | 0.4(0.20,0.73) | 0.73(0.40,0.73) | -1.638 | 0.101 |
LDH (CSF) (U/L) | 28(22,54) | 50(34,54) | -2.004 | 0.045 |
CL (CSF) (mmonl/L) | 121.50(120.70,125.30) | 120.70 (120.70, 123.67) | -1.384 | 0.166 |
NHISS (at discharge) | 0.00(0,1) | 0.5(0,1.75) | -1.798 | 0.072 |
Treatment method Low molecular heparin Intravascular treatment | 50 (96.15%) 2 (3.84%) | 17 (100%) 0 (0) | 0.673 | 0.412 |
Prognosis Improved Exacerbation/complications Death | 50 (96.15%) 1 (1.92%) 1 (1.92%) | 14 (82.35%) 3 (17.65%) 0 (0) | 9.393 | 0.024 |
DSA: Diseased sinus amount, SBP: Systolic blood pressure, DBP: Diastolic blood pressure, WBC: White blood cell count (× 109/L), LR: Lymphocyte ratio, MCV: Mean corpuscular volume, USG: Urine specific gravity, HBs-Ab: Hepatitis B surface antibody, BUN: Blood urea nitrogen, ICP: Intracranial pressure, CSF: Cerebrospinal fluid, ADA: Adenosine deaminase, LDH: Lactic dehydrogenase, NHISS: the National Institutes of Health Stroke Scale, LWMH: Low molecular heparin. |
Among all CVT patients, 47.82% of them were at the acute stage; 33.33% were at the subacute stage; and 18.84% were at the chronic stage. The proportions of headache patients at acute, subacute, and chronic stages were 53.84% (28/52), 28.84% (15/52), and 17.30% (15/52), respectively. In the non-headache group, the percentage of patients at acute, subacute, and chronic stages were 64.70% (11/17), 29.41% (5/11), 9%(1/11), respectively.
Head and face infection or upper respiratory infection occurred in 27.68% (26/69) of all CVT patients. There was no significant difference in the NHISS between headache and non-headache groups (0.0 [0.0, 1.00] vs. 0.5 [0.0, 1.75], P = 0.072). Among all participants, 67 of them received anticoagulant therapy (low molecular heparin, 5000 IU, subcutaneous injection, b.i.d.) for two weeks. Two patients received intravascular treatment. At discharge, 92.75% of all patients had an NHISS of 0, indicating that they were in relatively good condition; 7.25% of them were in a relatively poor condition (NHISS > 1); 4 patients were in coma. One patient from the head group died during hospitalization (Table 1). The result of VAS-100 in patients with headache was 70.12 ± 13.8.
Compared with the non-headache group, patients with headache had lower median age (37 [27,45] vs. 50 [38, 67], P = 0.004), MCV (88.10 [84༌91] vs. 90.4 [88.65, 92.40], P = 0.035), levels of BUN (3.5 [2.80, 4.15] vs. 4.75 [3.90, 6.00], P = 0.002), protein (CSF) (0.55 [0.284, 0.605] vs. 0.605 [0.605, 0.995], P = 0.002), LDH (CSF) (28 [22, 54] vs. 50 [34, 54], P = 0.045), and higher LR (0.25 [0.17, 0.32] vs. 0.17 [0.14, 0.24], P = 0.038) and ICP (234 [200, 290] vs. 200 [171.25, 234], P = 0.025). However, there was no significant difference in NHISS, DSA, DBP, WBC, L, USG, level of ADA (CSF), and treatment method between the two groups. The headache group had better outcomes at discharge (X2 = 9.393, P = 0.024) (Table 1, Fig. 2).
The Spearman’s correlation analysis showed that the younger age (r = 0.352, P = 0.003), gender of female (r = 0.272, P = 0.026), increased LR (r = 0.252, P = 0.037) and ICP (r = 0.271, p = 0.024) were positively correlated with the occurrence of headache, whereas decreased MCV (r=-0.256, P = 0.034), lower levels of BUN (r=-0.370, P = 0.002) and protein (CSF) (r=-0.376, P = 0.001) were negatively correlated with the onset of headache in CVT patients (Table 2).
Table 2
Correlations between demographic/clinical characteristics and the occurrence of headache in CVT patients
| r-value | P-value |
Age (years) Gender LR(%) ICP (mg/L) BUN (mg/L) MCV(ng/L) | 0.352 | 0.003 |
0.272 | 0.026 |
0.252 | 0.037 |
0.271 | 0.024 |
-0.370 | 0.002 |
− 0.256 | 0.034 |
Protein (CSF)(g/L) | − 0.376 | 0.001 |
LR: Lymphocyte ratio, MCV: Mean corpuscular Volume, BUN: Blood urea nitrogen,ICP: Intracranial pressure, CSF: Cerebrospinal fluid. r: Relation coefficient. |
We further performed binary logistic regression analysis to identify the risk factors for headache in CVT patients. The occurrence of headache was defined as a dependent variable and the independent variables included DBP, SBP, NHISS, WBC, L, LR, MCV, USG, ICP, levels of HBs-Ab, BUN, protein (CSF), ADA (CSF), LDH (CSF), CL− (CSF), and NHISS (at discharge). The results showed that younger age (adjusted odds ratio (OR) = 0.912, 95% confidence interval (CI): 0.840–0.990, P = 0.029] and the increased level of CL− (CSF) (adjusted OR = 1.742, 95% CI: 1.037–2.927, P = 0.036) were the predictive factors for the occurrence of headache in CVT patients (Table 3).
Table 3
Binary logistic regression analysis
| B | S.E | Walds | p-value | Exp (B) | EXP(B) 95% C.I. |
Gender | 1.775 | 1.756 | 1.022 | 0.312 | 5.902 | 0.189 | 184.455 |
Age(years) | − .0092 | 0.042 | 4.789 | 0.029 | 0.912 | 0.840 | 0.990 |
SBP (mmHg) | -0.104 | 0.056 | 3.442 | 0.064 | 0.901 | 0.807 | 1.006 |
DBP (mmHg) | 0.078 | 0.055 | 2.063 | 0.151 | 1.082 | 0.972 | 1.204 |
NHISS | -0.155 | 0.219 | 0.499 | 0.480 | 0.857 | 0.557 | 1.316 |
WBC(× 109/L) | 0.282 | 0.312 | 0.819 | 0.365 | 1.326 | 0.720 | 2.443 |
PLT(× 1012/L) | -0.010 | 0.007 | 2.132 | 0.144 | 0.990 | 0.978 | 1.003 |
DSA | 0.046 | 0.465 | .010 | 0.922 | 1.047 | 0.421 | 2.605 |
ICP(mg/L) | 0.015 | 0.011 | 2.130 | 0.144 | 1.016 | 0.995 | 1.037 |
CL−(CSF) (mmonl/L) | 0.555 | 0.265 | 4.393 | 0.036 | 1.742 | 1.037 | 2.927 |
LDH(CSF) (U/L) | -0.006 | 0.011 | .258 | 0.612 | .994 | 0.973 | 1.016 |
BUN(mg/L) | -0.101 | 0.538 | 0.035 | 0.851 | 0.904 | 0.315 | 2.594 |
L(× 109/L) | -1.929 | 1.779 | 1.176 | 0.278 | 0.145 | 0.004 | 4.747 |
PT(second) | 0.163 | 0.303 | 0.289 | 0.591 | 1.177 | 0.650 | 2.133 |
Fibrinogen(g/L) | -0.130 | 0.428 | 0.093 | 0.761 | 0.878 | 0.380 | 2.030 |
SBP: Systolic blood pressure, DBP: Diastolic blood pressure, NHISS: the National Institutes of Health Stroke Scale, WBC (× 109/L): White blood cell count, PLT: Blood platelet, DSA: Diseased sinus amount, ICP: Intracranial pressure, CSF: Cerebrospinal fluid, LDH༚Lactic dehydrogenase BUN: Blood urea nitrogen, L: Lymphocyte, PT: Prothrombin time. |