Long-term headache following cerebral venous thrombosis: a systematic review

Cerebral venous thrombosis (CVT) predominantly affects young adults and frequently presents with headache. Although functional outcomes are generally favorable, many patients report persistent or recurrent headache long after the acute event. This systematic review aimed to assess the prevalence, clinical characteristics, associated factors, and management of long-term headache following CVT.

A systematic search of PubMed and Embase (2000-2025) identified studies reporting original data on long-term headache after CVT in adult populations. Case series including fewer than 30 patients were excluded. Given substantial heterogeneity in study design, definitions, and outcome measures, a qualitative synthesis was performed. Fifteen studies including 2,136 patients were analyzed. The reported prevalence of post-CVT headache ranged from 14% to 59%. Headache most often resembled primary headache disorders, particularly tension-type and migraine-like phenotypes. Available data suggest that de novo headache may represent the most frequent presentation, although modification of pre-existing headache disorders also occurs. Pre-existing headache and depression were associated with post-CVT headache, whereas intracerebral hemorrhage was not. Associations with venous recanalization, thrombosis location, and anticoagulation delay were inconsistent. Secondary mechanisms, including intracranial hypertension, dural arteriovenous fistula, CVT recurrence, and medication-overuse headache, were identified in some patients. Data on management strategies were limited.

Long-term headache is a frequent but under-recognized complication of CVT that may significantly impact quality of life. The absence of a standardized definition contributes to heterogeneity across studies. After exclusion of secondary causes, post-CVT headache encompasses both de novo and modified primary headache phenotypes. A consensus term such as "new or modified recurrent headache attributed to past CVT" may help describe this spectrum and improve clinical characterization and future research.