Skip to main content

Research Repository

Advanced Search

Relationship between nitrate headache and outcome in patients with acute stroke: results from the efficacy of nitric oxide in stroke (ENOS) trial

Beishon, Lucy; Woodhouse, Lisa J; Bereczki, Daniel; Christensen, Hanne K; Collins, Ronan; Gommans, John; Kruuse, Christina; Ntaios, George; Ozturk, Serefnur; Phillips, Stephen; Pocock, Stuart; Szatmari, Szabolcs; Wardlaw, Joanna; Sprigg, Nikola; Bath, Philip M

Relationship between nitrate headache and outcome in patients with acute stroke: results from the efficacy of nitric oxide in stroke (ENOS) trial Thumbnail


Authors

Lucy Beishon

Daniel Bereczki

Hanne K Christensen

Ronan Collins

John Gommans

Christina Kruuse

George Ntaios

Serefnur Ozturk

Stephen Phillips

Stuart Pocock

Szabolcs Szatmari

Joanna Wardlaw

NIKOLA SPRIGG nikola.sprigg@nottingham.ac.uk
Professor of Stroke Medicine

PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine



Abstract

Introduction Nitrate-induced headache is common and may signify responsive cerebral vasculature. We assessed the relationship between nitrate headache and outcome in patients with acute stroke. Materials and methods Patients were those randomised to glyceryl trinitrate (GTN) versus no GTN in the efficacy of nitric oxide in stroke trial. Development of headache by end of treatment (day 7), and functional outcome (modified Rankin Scale, primary outcome) at day 90, were assessed. Analyses are adjusted for baseline prognostic factors and give OR and mean difference (MD) with 95% CI. Results In 4011 patients, headache was more common in GTN than control (360, 18.0% vs 170, 8.5%; p<0.001). Nitrate-related headache was associated with: younger age, female sex, higher diastolic blood pressure, non-total anterior circulation syndrome, milder stroke and absence of dysphasia (p<0.05). Nitrate headache was not associated with improved functional outcome (OR 0.90, 95% CI 0.73 to 1.10, p=0.30) or death (day 90) (HR 0.64, 95% CI 0.40 to 1.02, p=0.062), but reduced death or deterioration (day 7) (OR 0.45, 95% CI 0.25 to 0.82), death in hospital (OR 0.44, 95% CI 0.22 to 0.88) and improved activities of daily living (Barthel index, MD 3.7, 95% CI 0.3 to 7.1) and cognition (telephone interview cognitive screen, MD 2.0, 95% CI 0.7 to 3.3) (day 90). Non-nitrate headache was not associated with death, disability or cognition. Discussion and conclusion Development of a nitrate headache by day 7 after stroke may be associated with improved activities of daily living and cognitive impairment at day 90, which was not seen with non-nitrate headache.

Citation

Beishon, L., Woodhouse, L. J., Bereczki, D., Christensen, H. K., Collins, R., Gommans, J., …Bath, P. M. (2021). Relationship between nitrate headache and outcome in patients with acute stroke: results from the efficacy of nitric oxide in stroke (ENOS) trial. Stroke and Vascular Neurology, 6(2), 180-186. https://doi.org/10.1136/svn-2020-000498

Journal Article Type Article
Acceptance Date Sep 15, 2020
Online Publication Date Nov 5, 2020
Publication Date 2021-06
Deposit Date Oct 1, 2020
Publicly Available Date Mar 29, 2024
Journal Stroke and Vascular Neurology
Electronic ISSN 2059-8696
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 6
Issue 2
Article Number e000498
Pages 180-186
DOI https://doi.org/10.1136/svn-2020-000498
Keywords Cardiology and Cardiovascular Medicine; Clinical Neurology
Public URL https://nottingham-repository.worktribe.com/output/4936355
Publisher URL https://svn.bmj.com/content/early/2020/11/05/svn-2020-000498

Files




You might also like



Downloadable Citations