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.
Ofima et al. (2026) studied this question.