Pain Outcomes and Exercise Data from the EXERT-Stroke Pilot Clinical Trial on Post-Stroke Headaches

Chronic pain affects 30-50% of stroke survivors and is more complex in US veterans. This study aimed to evaluate the feasibility, safety, and preliminary effects of combined repetitive transcranial magnetic stimulation (rTMS) and aerobic exercise in veterans. We conducted a secondary analysis of the EXERT-Stroke trial, a pilot randomized, sham-controlled, double-blind study. Veterans with persistent post-stroke headache completed standardized aerobic exercise across 10 supervised sessions over 8weeks. Pain was assessed weekly via the Brief Pain Inventory (BPI) and Visual Analogue Scale (VAS). Baseline exercise capacity, blood pressure (BP), and heart rate were also measured. Linear regression examined associations between baseline physiological measures and changes in pain. Nine veterans (77.8% male, mean age 61.3 years) participated. Overall, participants experienced a mean decrease of 1.2 in pain severity and 1.0 in pain interference. Higher baseline resting and maximal systolic BP, and higher baseline resting diastolic BP, were associated with greater improvements in pain severity. Combined rTMS and aerobic exercise is feasible, safe, and may reduce post-stroke pain in veterans.This study provides preliminary support for a novel, nonpharmacologic intervention targeting chronic post-stroke pain in veterans, a population with limited treatment options and high rehabilitation needs.Trial registration: This trial was registered at clinicaltrials.gov (Registration No. [NCT04672044]) on 2020-12-11 (URL: https://clinicaltrials.gov/study/NCT04672044?cond=stroke&intr=rtms&aggFilters=docs:prot,funderType:fed,status:com,studyType:int&rank=2).