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Long-term headache following cerebral venous thrombosis: a systematic review
Diana Doukhi1,2,3,4, Jerome Mawet5,6, Caroline Roos5,6,7
1Emergency Headache Center (Centre d'Urgences Céphalées), Department of Neurology, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France. diana.doukhi@aphp.fr.
Insights
Long-term headache is a common complication after cerebral venous thrombosis (CVT), often resembling primary headache disorders. Identifying and managing this persistent post-CVT headache is crucial for patient quality of life.
Area of Science:
- Neurology
- Vascular Neurology
- Headache Medicine
Background:
- Cerebral venous thrombosis (CVT) primarily affects young adults, frequently presenting with headache.
- Persistent or recurrent headache is a common sequela of CVT, impacting long-term quality of life.
- This review assesses the prevalence, characteristics, and management of long-term headache post-CVT.
Purpose of the Study:
- To systematically review the literature on long-term headache following cerebral venous thrombosis.
- To determine the prevalence, clinical features, associated factors, and management strategies for post-CVT headache.
Main Methods:
- Systematic search of PubMed and Embase (2000-2025) for studies on adult CVT.
- Inclusion of 15 studies with 2,136 patients; exclusion of case series <30 patients.
- Qualitative synthesis due to heterogeneity in study design and outcome measures.
Main Results:
- Prevalence of post-CVT headache ranged from 14% to 59%.
- Headache phenotypes commonly mimicked primary disorders like tension-type or migraine.
- Pre-existing headache and depression were associated factors; intracerebral hemorrhage was not.
Conclusions:
- Long-term headache is a frequent, under-recognized complication of CVT.
- Post-CVT headache includes de novo and modified primary headache phenotypes after excluding secondary causes.
- A consensus term is proposed to improve characterization and research into this condition.
Background:
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.
Main Body:
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.
Conclusion:
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.
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