Abstract DP048: Headache After Hemorrhagic Stroke: A Systematic Review and Meta-analysis

Background/Objective: Hemorrhagic stroke comprises about 20% of all strokes, with intracerebral hemorrhage (ICH) being the most common type. While post-stroke care often focuses on motor and functional recovery, post-stroke headaches remain underrecognized and understudied. This study aimed to evaluate the estimated prevalence and patterns of headaches after hemorrhagic stroke. Methods: We queried Medline, Embase, and CENTRAL databases to identify studies that investigated headaches after hemorrhagic stroke. Studies enrolling ≥5 adult patients were included. Meta-analyses were conducted to estimate pooled prevalence of overall, acute/subacute, chronic, and severe headaches. Meta-regression was performed to examine heterogeneity and potential moderators. Acute/subacute headache was defined as onset within 3 months of stroke, while chronic headache as persistence beyond 3 months. Severe headache was defined as either a ≥7/10 pain intensity or functional impairment. Results: Twenty-four studies comprising 4,688 patients (58.2% female; mean age 56.9) were included. Meta-analysis revealed an overall pooled headache prevalence of 43% (95% confidence interval [CI]: 35%–52%) following hemorrhagic stroke. Stratified analyses showed that the prevalence was 58% (95% CI: 44%–72%) in patients with subarachnoid hemorrhage (SAH) and 36% (95% CI: 27%–46%) in those with ICH. Acute headache occurred in 50% (95% CI: 39%–61%), while chronic headache occurred in 37% (95% CI: 26%–49%). Severe headaches were reported in 41% (95% CI: 15%–70%) of patients with acute/subacute headache and 14% (95% CI: 10%–19%) with chronic headache. In both SAH and ICH, headaches frequently become chronic and persistent. Meta-regression did not identify significant moderators by study design, geographic region, human development index, or risk of bias. Conclusion: Headache is a common but understudied condition that can manifest at or soon after a hemorrhagic stroke and can persist for years, potentially contributing to long-term morbidity. Standardized headache definitions and longitudinal assessments are needed to improve recognition and inform future clinical trials targeting this underappreciated source of post-stroke morbidity. Further research is essential to better understand the nature of these headaches, which will help shape treatment protocols and enhance patient care.