Coping With Headaches After a Stroke

A stroke causes neurological effects that correspond to injured regions of the brain. Headaches can start after a stroke, but are not necessarily correlated to the location of a stroke within the brain.

About 10-15% of stroke survivors begin to experience new headaches shortly after a stroke. Headaches that begin for the first time after a stroke may fall into several headache categories. Post-stroke headaches can be either migraine headaches, tension headaches, medication overuse headaches, or medication side effects.

What You Should Do About Post-Stroke Headaches

Headaches can be bothersome, but may also be alarming. If you begin to experience headaches after a stroke, it is important to talk to your doctor about your headaches for two reasons. First of all, you need to make sure that your post-stroke headaches are not an indication of a serious problem. Most of the time, headaches do not turn out to be the sign of anything worrisome. Your doctor can determine whether your headaches are a sign of something more significant.

The second reason to get medical attention for your headaches is that headaches are treatable. The treatment depends on which type of headache you are experiencing.

Types of Post-Stroke Headaches

  • Medication overuse headaches are the consequence of excessive pain medication. The use of pain medication generally provides temporary relief for a few hours, often followed by a mild withdrawal effect that can induce pain. Your health care provider can develop a program for you to gradually decrease the use of pain medication so that you will not continue to suffer from medication overuse headaches.
  • Tension headaches cause head pain and are not normally associated with other symptoms. Tension headaches are usually relatively easy to control with mild medication and rest.
  • Migraine headaches are generally very painful and may be associated with nausea, neurological symptoms and an overwhelming sense of fatigue. Migraine headaches may require powerful prescription medications. Because some migraine medications are not recommended for people with heart disease or stroke, a neurologist is often needed to manage post-stroke migraine headaches.
  • One of the medications commonly used after a stroke may cause headaches. Dipyridamole is a blood thinner used to prevent strokes. It can trigger headaches in some patients, possibly because it causes blood vessels to widen (dilate.) Migraine headaches are one of the side effects of dilated cerebral blood vessels. Interestingly, this headache side effect does not necessarily make dipyridamole a bad guy. A recent study published in the October 2014 issue of the European Journal of Neurology reported that stroke patients who suffered from dipyridamole induced headaches actually had fewer recurrent strokes than patients who did not experience headaches as a side effect.

Why Do Post-Stroke Headaches Occur?

After a stroke, it is not uncommon for patients to develop new pain symptoms. Some patients notice new joint pain, shoulder pain or skin pain after a stroke, with as many as 1/3 of patients complaining of pain severe enough to interfere with daily activities. Headaches are similar to other types of post-stroke pain patterns but have their own unique characteristics. The root source is not completely understood, and may be related to a number of causes. Stroke-induced injury to sensory regions of the brain can trigger pain.

Alterations in the electrical activity of the brain after the damage of a stroke can lead to pain. The changes in blood flow in the brain after a stroke can produce pain, particularly head pain.

Headaches may start for the first time after a stroke. They are manageable, and most of the time, stroke-induced headaches are not a sign of a serious problem.


Hansen AP, Marcussen NS, Klit H, Kasch H, Jensen TS, Finnerup NB, Development of persistent headache following stroke: A 3-year follow-up, Cephalagia,  August 2014

Hansen AP, Marcussen NS, Klit H, Andersen G, Finnerup NB, Jensen TS, Pain following stroke: a prospective study, European Journal of Pain, September 2012

Davidai G, Cotton D, Gorelick P, Bath PM, Lipton RB, Sacco R, Diener HC, Dipyridamole-induced headache and lower recurrence risk in secondary prevention of ischaemic stroke: a post hoc analysis, European Journal of Neurology, October 2014

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