From the Guidelines
Frequent headaches in a post-stroke patient are often caused by a combination of factors, including post-stroke depression, cognitive impairment, and medication side effects, and should be evaluated and managed by a healthcare provider to improve quality of life and reduce morbidity and mortality. When evaluating the cause of frequent headaches in a post-stroke patient, it is essential to consider the patient's cognitive trajectory, which can be affected by multiple factors, including stroke location, preexisting cognitive impairment, small-vessel disease, and comorbidities, as well as sociocultural and demographic characteristics 1. Some key factors to consider when evaluating post-stroke headaches include:
- Post-stroke depression, which is common and can be accompanied by cognitive symptoms, making it challenging to differentiate from primarily post-stroke cognitive impairment (PSCI) 1
- Cognitive impairment, which can be caused by vascular cognitive disorders, such as covert cerebral small-vessel disease, or age-related neurodegenerative diseases, such as Alzheimer's disease (AD) 1
- Medication side effects, which can contribute to headache development and exacerbation 1
- Other potential causes, such as infection, constipation, pain, and electrolyte imbalances, which should be assessed and managed accordingly 1 To manage post-stroke headaches effectively, a comprehensive approach is necessary, including:
- Pharmacological interventions, such as acetaminophen or NSAIDs, which can be used to alleviate headache symptoms, but should be used cautiously due to potential bleeding risks
- Non-pharmacological approaches, such as adequate hydration, regular sleep patterns, stress management, and physical therapy, which can help reduce headache frequency and severity
- Regular follow-up with a neurologist to monitor stroke recovery and adjust headache management as needed 1.
From the Research
Causes of Frequent Headaches in Post-Stroke Patients
The causes of frequent headaches in post-stroke patients can be attributed to several factors, including:
- Persistent post-stroke headache, which affects up to 23% of patients 2
- Central post-stroke pain (CPSP), which is caused by the brain lesion itself and can be a result of hyperexcitation in the damaged sensory pathways or damage to the central inhibitory pathways 3
- Other factors such as obstructive sleep apnea, musculoskeletal imbalances, lack of sleep, and infarct in cerebellum 2, 4
Risk Factors
Risk factors for developing frequent headaches in post-stroke patients include:
- Younger age 2, 5
- Female sex 2, 5, 6
- Pre-existing headache disorder 2
- Comorbid post-stroke fatigue or depression 2
- Stroke of undetermined etiology 4
- Less than 8 points by NIHSS score 4
- Low prevalence of large-artery atherosclerosis 4
Clinical Characteristics
The clinical characteristics of frequent headaches in post-stroke patients include:
- Tension-type features 2, 5
- Mild to moderate bilateral pain, not associated with nausea, vomiting, photophobia, or phonophobia 5
- Concomitant onset with focal neurologic deficit and improvement over time 5
- Slowly decreasing frequency and development of medication overuse headache in one-third of the patients 4