Clinical characteristics of persistent post-stroke headache: a comparative analysis with chronic cerebral ischemia and various types of stroke

Objective. To clarify clinical characteristics, time parameters and associated symptoms of persistent post-stroke headache (PSPH).

Materials and methods. A cohort study was conducted at the neurological and rehabilitation departments of the Gomel University Clinic – Regional Hospital for Disabled Veterans of the Great Patriotic War for the period from 2018 to 2024. The study included three groups: a main group of patients with post-stroke headache, a comparison group for individuals with chronic cerebral ischemia (CCI), and a retrospective follow-up survey group. The main group included 45 patients in the recovery period of acute cerebrovascular accident (ACVA) with PDPH (mean age 61.1±13.5 years old; 40 with cerebral infarction (CMI), 5 with intracerebral hemorrhage (ICH). The comparison group consisted of 36 patients with CCI. We used a visual analog scale (VAS), Douleur Neuropathique4 (DN4) scale, PainDetect, McGill questionnaire, central sensitization scale, Beck and Spielberger-Khanin questionnaires to describe the pain syndrome. The follow-up group (n=70) was surveyed using a telephone interview. Statistical processing was performed using the Statistica 12.0 software package.

Results. Patients with CCI, compared to those with PDPH, have higher values of the McGill Pain Questionnaire – number index of selected descriptors of the sensory scale (p=0.03), the evaluative scale (p= 0.016), as well as the central sensitization questionnaire (p<0.0005) and Spielberger’s personal anxiety (p=0.019). In case of ICH, the average and severe pain over the last 4 weeks reached 10 points on the VAS, which is significantly higher than with IHM (p=0.005 and p=0.001). PDPH debuted in the first 3 months in 92.9% of patients; constant pain was recorded in 21.4%. Sensory symptoms (numbness, paresthesia) occurred in 21.2%, sleep disturbance – in 19.2%.

Conclusion. PDPH represents a heterogeneous condition with various pathophysiological occurance mechanisms. A differentiated approach to diagnosis and treatment based on the temporal, qualitative, and sensory characteristics of pain will improve rehabilitation outcomes and quality of life for this group of patients.

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