What might the problem be?

Incorrect positioning

Poor positioning in bed/chair can cause headaches. Cervical misalignment, either through visuospatial inattention or lack of support, could contribute to headache.

Anxiety

Anxiety and depression are common after stroke and are associated with headache.

Injury

Injury such as subdural haematoma (SDH) or whiplash could be sustained at the time of stroke.

Environmental factors

e.g. noise, bright light, unpleasant odours can cause headaches.

Infection

Common sources of infection such as chest, urine and skin can all cause headaches.

Dehydration

Stroke patients often have inadequate oral fluid intake due to swallowing problems.

Visual impairment

Visual disturbance e.g. diplopia can cause headaches as the patient struggles to focus.

Medication side effects

Headache is a common side effect of dipyridamole, which is used much less for stroke prevention now that newer drugs are available.

Pre-stroke headaches e.g. migraine

People who have migraine have an increased stroke risk.

Intracerebral haemorrhage (ICH)

ICH is more likely to cause headache than a cerebral infarct and it is important to ensure that it is detected, which requires a brain scan.

Alcohol or nicotine withdrawal

Alcohol or nicotine withdrawal commonly causes headaches.

Extension of initial stroke

An increase in size of the original area of brain affected by the stroke can cause headache – this would usually be detected on a brain scan.

Arterial dissection

Arterial dissection refers to the abnormal, and usually abrupt, formation of a tear along the inside wall of an artery It causes around 2% of all strokes, although possibly up to 25% of all strokes in people aged under 50 years.