Can pain be a sign of impending stroke?

1 answer | Last updated: Sep 14, 2017
Pixie asked...

My mother-in-law had a small stroke three weeks ago and is still disoriented and complains daily about the pain on her right side of her head. She's had this pain for about four months. Is this a pre-warning to another stroke?

Expert Answers

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Assuming this is an "ischemic" stroke - or one in which the stroke is caused by a blockage of blood flow - chronic pain is not typically a sign of an impending stroke, with a few exceptions.  These would include 1) a tight blockage of an artery or 2) a torn artery.  Both of these are very rare causes of a stroke. 

In the case of a tight blockage, a headache results because other arteries are trying to help supply blood flow to the part of the brain that is lacking sufficient blood flow, and the arteries dilate to do this.  This dilation causes pain.  If the lack of blood flow persists for long enough, a stroke can ensue. 

In the case of a torn artery, the tear itself is often painful.  At the site of the tear, a small clot can form, and lead to a stroke.

Both of these issues can be evaluated by arterial imaging.  I would recommend you check with your doctor about getting some arterial imaging scans (almost always performed non-invasively).  If these are negative, the headache is most likely benign, but should be treated aggressively.

That said, I would first make sure that your mother-in-law actually had an "ischemic" stroke.  Other possibilities are that she had bleeding which caused a stroke.  Your doctor should quickly be able to tell you if the stroke was "ischemic", or from a bleed.  Bleeding strokes can cause headaches for a variety of different reasons.  These should be identifiable with images of the brain and it arteries and veins.

In general, it sounds like she needs imaging of the brain and vessels (if not already completed) to find the source of the headaches.  If no source is found, the headaches are most likely benign, but should still be treated aggressively as they can be quite debilitating.