Chronic Headache after Stroke
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.
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