Home > Neurology > EHC 2022 > Breakthroughs in Understanding Headache > Persistent headache after stroke: not rare and often overlooked

Persistent headache after stroke: not rare and often overlooked

Presented By
Prof. Elena Lebedeva, Ural State Medical University, Russia
EHC 2022

Persistent headache attributable to ischaemic stroke is not rare and frequently leads to medication overuse. It has a considerable impact on quality of life and should be monitored during the follow-up of stroke patients. These were the main conclusions drawn from a Russian study of this often neglected problem.

Persistent headache after ischaemic stroke is increasingly acknowledged and was added to the 3rd edition of the International Classification of Headache Disorders (ICHD-3) in 2018 [1]. Prof. Elena Lebedeva (Ural State Medical University, Russia) and colleagues set up a study with 550 patients who had experienced a first-ever ischaemic stroke [1,2]. The study aimed to determine the incidence of headache attributed to stroke; describe its characteristics and acute treatment; evaluate risk factors; and analyse the prevalence of medication overuse headache (MOH).

Of 550 participants, 82 (15%) had headache at the onset of first-ever ischaemic stroke. This was a new type of headache in 8.4%, headache with altered characteristics in 5.4%, and a usual headache without any changes in 1.2%. By contrast, none of the participants in the control group experienced a new type of headache, and only 2 had a headache with altered characteristics (P<0.009). These 2 types of headaches are causally related to ischaemic stroke, Prof. Lebedeva inferred. Of controls, 9 (4.6%) had a usual headache.

Of this cohort, 529 patients were followed up for at least 3 months after stroke. In this group, 61 (11.5%) had a headache after stroke; 34 (6.4%) experienced a new type of headache, 21 (4.0%) had a headache with altered characteristics, and 6 (1.2%) had an unchanged headache. The 55 patients with persistent headache attributable to stroke had less severe accompanying symptoms and a slowly decreasing frequency; one-third developed MOH. In patients with a new type of headache, migraine-like headache was the most prevalent (n=20); in patients with a headache with altered characteristics, a tension-type headache was the most prevalent (n=16). The most important factors associated with persistent headaches were a score of <8 points on the NIHSS (90.9%, P=0.007), stroke of undetermined aetiology (50.9%; P=0.003), and lack of sleep (29.1%; P=0.009).


Prof. Lebdeva summarised the following take-home messages:

    • Take your time to take the history of headache at stroke onset and for headache that persists for >3 months after stroke.
    • Remember to diagnose and treat persistent headache after stroke and prevent MOH in these patients.


    1. Lebedeva ER. Persistent headache after first-ever ischemic stroke: clinical characteristics and factors associated with their development. Abstract A44, EHC 2022, 07-10 December, Vienna, Austria.
    2. Lebedeva ER, et al. J Headache Pain. 2022;23(1):103.


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