Post-Hemorrhagic Stroke Headaches: A Neglected Aspect of Recovery

MINNEAPOLIS-New research reveals that nearly half of hemorrhagic stroke patients experience headaches, with over a third reporting severe pain, highlighting a critical yet often neglected area of post-stroke care. Despite the prevalence of post-stroke headaches, notably following hemorrhagic stroke, management strategies remain underdeveloped, according to Bradley Ong, MD, a neurology resident at the Cleveland Clinic, who presented the findings at the American Headache Society (AHS) Annual Meeting 2025.

The Overlooked Reality of Post-Stroke Headaches

While stroke research heavily focuses on immediate interventions like stopping bleeding and reducing disability, the long-term impact of post-stroke headaches remains understudied. A systematic review and meta-analysis, encompassing 24 studies through December 2024, sought to bridge this knowledge gap. The analysis, which included data from 4,671 hemorrhagic stroke patients, revealed that 47% developed headaches, with 56% experiencing acute or subacute headaches within 30 days and 39% developing chronic headaches lasting over three months.

Did You Know? Post-stroke headaches can persist for months or even years after the initial stroke event.

Types and Severity of Post-Stroke Headaches

The study further distinguished between headache types based on the nature of the hemorrhagic stroke. Patients who experienced a subarachnoid hemorrhage (SAH) frequently enough reported migraine-like headaches, while those with intracerebral hemorrhage (ICH) typically described tension-type headaches, ranging from moderate to severe.Notably, nearly 38% of patients with post-stroke headaches progressed to the chronic phase, underscoring the need for long-term management strategies.

Factors Influencing Post-Stroke Headache Risk

Several factors can influence the likelihood of developing post-stroke headaches. According to the research, males had lower odds of developing headaches (pooled odds ratio [OR], 0.82; 95% CI, 0.68-0.99), while a prior history of headaches significantly increased the risk (pooled OR, 4.83; 95% CI, 2.10-11.10). These findings emphasize the importance of considering individual patient history when assessing and managing post-stroke headache risk.

The need for Improved Clinical Guidance and Research

Experts emphasize the urgent need for more prospective studies to better understand and address post-stroke headaches. Dr. Ong notes that common over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) are often unsuitable for patients who have experienced a brain bleed, further complicating treatment.Robert G.Kaniecki, MD, founder and director of the UPMC Headache Center in Pittsburgh, also highlighted the study’s strengths in focusing specifically on hemorrhagic stroke patients, noting that previous research frequently enough combined hemorrhagic and ischemic stroke cases.

Pro Tip: Clinicians should proactively include headache treatment as an integral part of stroke rehabilitation programs.

The lack of standardized definitions for post-stroke headache also poses a challenge to research and treatment efforts. More consistent data from diverse populations are needed to gain a complete understanding of the condition and develop effective treatments. Furthermore, understanding the relationship between post-stroke depression and headache progress warrants further inquiry, as headache is a frequent symptom reported by patients with depression.

Addressing the Knowledge Gap in Post-Stroke Headache Management

The findings underscore the necessity for increased awareness and improved management of post-stroke headaches, particularly following hemorrhagic stroke. By recognizing the prevalence, characteristics, and risk factors associated with these headaches, clinicians can provide more comprehensive and effective care to stroke survivors. Further research and the development of standardized treatment guidelines are crucial steps toward addressing this often-overlooked aspect of stroke recovery.

Persistent headache after stroke is a common issue, with up to 23% of patients affected [1]. These headaches frequently enough have tension-type features and can be more frequent and severe than acute stroke-related headaches.

Why do you think post-stroke headaches are often overlooked in clinical settings? what strategies can be implemented to prioritize headache management in stroke rehabilitation?