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Chronic Headache after Stroke

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It’s common to get a headache along with a stroke, or even in the days afterwards. But there is a significant percentage of patients who end up with chronic headache in the months and even years that follow.

It’s very difficult to study post-stroke headache and post-stroke pain in general. For one thing, we don’t understand exactly why it happens (in many cases), which means that we’re not always sure that the chronic headaches are a result of the stroke. Also, the connection between migraine and stroke is well known (see for example Migraine: Doubling the Risk of Stroke?). So it could be that many patients are experiencing a progression in migraine symptoms that may have happened with or without the stroke itself (see the 2019 study Headache after ischemic stroke).

However, typically, chronic headache connected to stroke has a more tension-type headache quality. It can be severe, but it usually lacks some of the tell-tale migraine symptoms such as sensitivity to light and nausea. Usually, but not always. The pain also tends to be more constant, and get worse over time.

There are some common known causes of post-stroke headache. For example, you may be experiencing a side effect from your medication.

But once we get past those common causes, things get a lot more difficult. (Stanford Medicine had the rather discouraging comment regarding post-stroke pain in general – “Medical treatment for post-stroke pain is generally disappointing”!)

At this point, it seems that post-stroke headache, or chronic headache after stroke, is as complex and variable as any kind of headache when it comes to treatment.

If you have experienced chronic headache symptoms after having a stroke, there are some important steps that you need to follow:

  • Record as much information as you can about your symptoms. When did they start? Have you noticed anything that triggers them? What are your symptoms? Are they constant, intermittent, increasing?
  • Talk to a doctor or specialist as soon as possible. As mentioned above, there are some common known causes. The solution may be obvious, and you can save yourself a lot of trouble by finding the right treatment early.
  • Consider talking to a headache specialist, and make sure she or he knows your medical history. You may need to look at current best treatments for this type of headache, but knowing your medical history (including details about your stroke(s)) may help the specialist find better customized treatments for you.
  • Take care of yourself. Relying only on the next medication can set you up for long term problems. Plus, many of the medications used for chronic post stroke headache have side effects that you’ll need to deal with as well. Eating healthy food, getting proper rest/sleep, engaging in face to face social activities on a regular basis, and slowly and steadily working on an exercise plan under your doctor’s care can make a huge difference. This should go along with medications or treatments that your doctor may recommend.

One treatment that has been used for post-stroke headache is rTMS – repetitive transcranial magnetic stimulation. rTMS is non-invasive and does not involve drugs. Instead, it uses magnetic pulses to stimulate certain parts of the brain. Researchers at the Birmingham VA Medical Center believe that using rTMS along with exercise could lead to better results. They are currently working on a study with veterans in the USA to test their theory.

More resources:

Chronic Migraine and Sleep Problems? Join this Trial…

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Do you have chronic migraine, and also trouble sleeping? This clinical trial may be for you!

Earlier this month, Bethany Martin, a migraine researcher at the University of Strathclyde in the UK, contacted me regarding a new clinical trial. This may be a great opportunity for you to further investigate your own migraine and sleep challenges, but it will also be a help to others.

Here’s the official summary:

Do you experience chronic migraines and sleep problems? We are currently recruiting participants for a research study testing two digital sleep treatments.   The MISSION Study research team are looking for individuals aged 16 and over that experience chronic migraines and sleep problems. Participating in this research would include completing questionnaires, sleep & headache diaries throughout and wearing an activity tracking device. A screening process is necessary to ensure eligibility to participate.   For more information or to take part, contact Bethany Martin at hass-research-missionstudy@strath.ac.uk or call +44 (0)7519 589266

Feel free to share this information with anyone else who may be interested.

Migraine and Sleep Study
(click for a larger image)

PEA Supplements for Migraine?

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Supplements don’t tend to have the rigorous and expensive testing behind them that drugs have, but there is a growing interest in PEA, or palmitoylethanolamide, for migraine pain.

Mirica

PEA is a fatty acid amid which is naturally found in the body. You also get it in your diet, especially if you eat eggs (eggs really are an amazing food). It has been specifically studied for over 60 years, showing a lot of promise as an anti-inflammatory and a pain killer, among many other possible applications.

It’s widely available, and is often recommended for joint pain. And, at least in the short term, it appears to be very safe. These days, it’s even being studied as a treatment for COVID-19 induced lung inflammation.

Long-term studies are lacking, and that is an issue because of its possible application as a headache and migraine preventative. However, because of its excellent safety profile so far, it’s even being studied in children (see this study – 600mg/day).

A study in Australia is looking for participants as I write, to study PEA as an abortive. Patients will take 700mg at the first signs of a migraine attack, and then another 700mg dose if the pain doesn’t go away. If you’re in the area and eligible, you might want to take part in this trial.

It’s always interesting to look at other possible applications of a medication or supplement, especially if you’re taking something as a preventative. PEA has a long list of “possible” benefits, but again, they mostly lack large, high-quality studies. (As I’ve said many times before, this is not necessarily a big strike against a supplement, especially if it seems to be quite safe. Large clinical trials take a lot of money, so a company needs to know they’ll get their money back when they invest. PEA is already widely available and relatively inexpensive, which means there is less monetary motivation for large long term trials. However, there is a lot of interest in PEA, and at least quite a few smaller trials, so there’s actually a fair bit of evidence out there, especially for pain management.)

One benefit that will interest many is its anti-viral and immunity benefits. It may also help fight depression, promote brain health, and fight menstrual pain. Read more here in this 2021 report – Palmitoylethanolamide: A Natural Compound for Health Management.

So although it may not top the list of migraine fighting supplements, if, for example, you’re also struggling with joint pain, or menstrual pain, you might want to give it a try (although I always recommend you talk to your doctor first). You can try it as they’re using it in the Australian study – to take when you start getting a headache or migraine attack. Or, you might want to try it as a preventative.

If you’re trying it as a preventative, it would be good to give it a test run of three months. But remember, we don’t have long-term studies, so do your research, watch for possible side effects, and talk to your doctor.

600-700mg a day is often recommended, but you’ll see anything from 300-1200 daily. For a good summary, see this information at WebMD – Palmitoylethanolamide (Pea). For more in-depth information of how PEA works, this information is a few years old, but still useful (though very technical): Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy

So You Have a Coin-Shaped Headache that won’t go away…

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As bizarre as it may sound to someone who has never had one, there is such a thing as a “coin-shaped” headache – very small and localized, but still painful.

nummular headache

Coin-shaped headache is actually an older term for what we now call nummular headache. Nummular is just one of those fancy medical terms – it comes from the Latin for “little coin”.

The “little coin” headache may actually be little, but it’s often larger than a coin – up to 6cm (about 2 1/3 inches). But it has a definite shape – either round or sometimes more of an oval. It can come and go, but it’s always a specific shape.

Nummular headaches are often on the top/upper back of the head (more rarely there may be more than one “coin” – but always a very localized area). The pain is usually somewhere between mild or moderate, although it can be severe.

But even though it’s usually not as severe as some other headaches, it finds other ways to make life difficult. Although the pain may last only for minutes or days, most often it becomes chronic, lasting for months. Worse pain may flare up at various times.

And it is often accompanied by other symptoms besides pain. For example, the skin may feel strange – numb, perhaps. Or may more sensitive than normal – a feeling of “pins and needles” or burning, or pressure, or just painful to a slight touch.

A new trial will be studying the connection of nummular headache to migraine. Do patients with nummular headache have migraine-like symptoms? If you have chronic nummular headache, you may want to keep an eye on this study: Observational Prospective Study on the Presence of Typical Migraine Features in Nummular Headache Patients: The Numamig Study

If you have a coin-like headache, it’s very important to get it checked out. As you might guess, there are other things that can cause similar kinds of pain. Rashes, such as shingles. Or other diseases, such as cancers.

If the pain is not severe, nummular headache may not be treated at all. It’s enough to know from your doctor that it’s nothing that’s likely to become more serious (such as cancer, of course).

The fact is that common headache treatments simply may not work in this case. However, some treatments have been tried – you can read a summary of some of them here. The most important thing is to rule out other causes, and then talk to your doctor about the best treatment for you.

For more information on nummular headache:

FitBit and Migraine

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The easier it becomes to track information, the more we want to do it. Although some people prefer to avoid the hassle, there are a growing number who are tracking as much health information as possible using their smart phone, and sometimes an additional device such as FitBit.

Apps such as Curelator and Migraine Buddy have helped many migraine patients track detailed information. It’s not that we want to look back and see how painful life has been over the past 30 days. It’s a way to find triggers, and possible solutions, to migraine attacks.

Fitbit One
Fitbit One
FitBit is one example of an “activity tracker”. It tracks things like how many calories you’re burning, how active you are in general, quality of sleep, the food you eat, heart rate, and more. As you may imagine, knowing and controlling your overall health can have a huge impact on your migraine symptoms. Here’s a promotional video for a recent incarnation of FitBit:

Using Power Sync for Fitbit, you can even sync FitBit data to your Apple Health data.

Kelley Nunn, blogger at My Migraine Brain, has used FitBit (read a bit about her tracking system here). Vera Sweeney, another blogger, has also written a little about using (and hiding!) FitBit.

The Mayo Clinic and Allergan will be working together with Second Opinion Health to test the use of FitBit and the Migraine Alert app (an upcoming app not yet available to the general public) to predict migraine attacks.

To find out more about the trial (which as I write it not yet open to participants), see Individualized Prediction of Migraine Attacks Using a Mobile Phone App and Fitbit (Migraine Alert).

You can request to try out Migraine Alert – just watch the video below for more information (it’s open to those with episodic migraine only at this point).

How about you? Do you use health tracking with your smart phone? Has it helped?

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The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.