Headache features of cerebellar ischemic strokes: Clinical and radiological-experiences of a single center

•Headaches are more frequent in vertebrobasilar strokes, especially in cerebellum.•The prevalence of cerebellar stroke with headache is 11% in our study.•Headaches are prevalent in left hemispheric, cortical/ juxtacortical, PICA ischemias.•They are associated with low morbidity unless there was a impaired conscious. The prevalence of headache in stroke has been reported between 8% and 34%. Determining the prevalence, features, and effects on prognosis of cerebellar ischemic strokes that presented with headache solely and/or with other cerebellar signs were the aims of our study.All patients diagnosed with cerebellar ischemia were included. Electronic medical records were reviewed. Patients have been followed up for 6th month. Descriptive statistics were generated. A total of 4763 patients were evaluated retrospectively, 200 patients had cerebellar ischemia and 22 patients of these cerebellar ischemias (11%) had a headache at initial presentation. Ataxia, dysarthria, dysmetria were the most common neurological findings. There was no significant difference whether ischemic lesion single or multiple and whether above or below 1.5 cm diameter. Ischemic lesions generally were in cortical/ juxtacortical layer. According to vascular perfusion areas, 54.5% patients’ ischemia was located in PICA (posterior inferior cerebellar artery) territory. Patients presenting with a headache, predominantly had left hemispheric (vermian > hemispheric > pedincular) involvement. Although these patients generally had high modified Rankin Scale scores at the first evaluation, they had low NIHSS (National Institutes of Health Stroke Scale) scores (0–5), and nearly all patients recovered, with low mRS at the 6-month follow-up.Cerebellar ischemic strokes with headache presentation are significantly prevalent in patients with left hemispheric, cortical/juxtacortical, PICA perfusion territory ischemias and are associated with low morbidity unless there was a conscious disorder. We believe this is one of the first studies that evaluated the clinical and radiological parameters of cerebellar stroke patients with headache.