Approaches to Managing Different Types of Post-Stroke Pain

Pain is one of the several unexpected consequences of stroke. Post-stroke pain is not typically among the early stroke symptoms, and it may take weeks or months for post-stroke pain to develop. Because it takes a while for post-stroke pain to begin, stroke survivors often consider the physical pain after a stroke to be related to "aging," stress, or something else.

It is important to have your post-stroke pain evaluated by your healthcare provider, because there are many effective medical treatments for it. While you are already doing the hard work of recovering from your stroke, you should not have to put up with muscle aches, soreness, burning, or any other type of preventable discomfort on top of everything else.

Shirtless man rubbing his neck in pain
peepo / Getty Images

Approaches to Different Types of Post-Stroke Pain

There are several different kinds of post-stroke pain, and each requires a tailored approach. So, if you personally have post-stroke pain and if you also know someone else who also has post-stroke pain, you might not be getting the same treatment if your pain is not in the same category.

Spasticity-Induced Pain

After a stroke, weakened muscles can become stiff or rigid. Often, stroke survivors experience muscle spasticity, which is characterized by abrupt, choppy movements of weak, tight muscles.

This post-stroke muscle spasticity and tightness may produce aching pain in the spastic muscles, as well as soreness of nearby muscles that are repeatedly strained or placed in an uncomfortable position.

If you have pain from your post-stroke muscle spasticity, you will likely need to take muscle relaxers by mouth, apply muscle-relaxing creams, and/or participate in physical therapy to help alleviate the spasticity. You may also need to take pain medicine if the discomfort continues despite therapy aimed at reliving the spasticity. Sometimes, when spasticity is persistent and does not improve with muscle relaxers, injections with botulinum toxin (botox) can help ease muscle tightness, also reducing the pain.

Central Pain

A type of pain called central pain affects about 10% of stroke survivors. Central pain is not well understood, and it is believed to be the result of a complex response of the brain to the stroke injury, resulting in hypersensitivity.

Most stroke survivors who have central pain complain of severe and persistent pain that may include aching, burning, tingling, tenderness or other unpleasant sensations. Generally, central pain is associated with strokes that cause moderate loss of muscle strength and mild to moderate decreased sensation, and not typically with strokes that cause a complete loss of strength or a complete loss of sensation.

Standard pain medications are not usually successful in controlling central pain. Anti-seizure medications and antidepressants have been found to be the most effective methods for reducing central pain.

The American Heart Association (AHA) treatment guidelines for post-stroke central pain recommend an individualized approach to determining the best treatment approach for patients, including a thorough consideration of response to treatment and any side effects.

Musculoskeletal Pain

Musculoskeletal pain is often described as a pain or aching of the muscles, often in the shoulders, neck, arms, legs, or back. Musculoskeletal pain is the most common type of post-stroke pain. It is unlike the discomfort of muscle spasticity and distinct from central pain, although some stroke survivors experience more than one type of post-stroke pain.

Musculoskeletal pain is usually mild to moderate in severity and typically improves with standard pain medications. However, sometimes, musculoskeletal pain can be so intense that it prevents you from exerting your full effort when you move your muscles, because routine movements may aggravate the pain. 

Post-stroke musculoskeletal pain can be one of the more substantial setbacks when it comes to stroke recovery and rehabilitation. Therefore, it is important to discuss your pain with your medical team, so that you can continue to recover at your most optimal level once you achieve pain control.


As many as 20% to 30% of stroke survivors begin to experience headaches for the first time after having a stroke. Some stroke survivors who already had headaches prior to the stroke may experience worsened headaches after a stroke. All strokes can trigger new headaches during the recovery period, but hemorrhagic strokes are the most highly associated with headaches during, and even after, stroke recovery.

Post-stroke headaches are not all the same. Post-stroke head pain can produce aching, throbbing, a sense of heaviness, nausea, dizziness, and fatigue. Some post-stroke headaches are tension headaches, some are migraine headaches, others are medication rebound headaches, and others are caused by blood pressure fluctuations.

If you or a loved one experience headaches after a stroke, you need a thorough evaluation by a neurologist, who can diagnose your specific headache type and provide you with the appropriate treatment. There are effective treatments available for headaches and you should not have to suffer from head pain while you recover from your stroke.

Phantom Limb Pain

Phantom limb pain is a relatively uncommon, yet agonizing type of pain. Phantom limb pain is most often described as pain coming from the location of an arm or a leg that has been amputated and, thus, does not even exist.

Yet, stroke survivors who have profound weakness or complete sensory loss can also feel as if their arm or leg is "not there," and may experience phantom limb pain. There are medications and rehabilitative therapeutic techniques for phantom limb pain. The treatment needs to be specifically tailored to the individual stroke survivor, because not everyone who suffers from phantom limb pain improves with the same treatment approach.

A Word From Verywell

Pain is an unwelcome and surprising stroke effect that usually begins well after the initial stroke phase stabilizes. The majority of stroke survivors experience some type of pain for a period of time, but the pain usually improves with medical treatment and, after a while, the physical discomfort might improve sufficiently enough that medical treatment is no longer needed.

Pain is a difficult problem to live with, and some people may be tempted to just "tough it out." However, there are effective treatment options for post-stroke pain, so you should know that you can experience your stroke recovery without the additional hardship of pain.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Treister AK, Hatch MN, Cramer SC, Chang EY. Demystifying poststroke pain: From etiology to treatmentPM R. 2017;9(1):63–75. doi:10.1016/j.pmrj.2016.05.015

  2. Francisco GE, McGuire JR. Poststroke spasticity management. Stroke. 2012;43(11):3132-6. doi:10.1161/STROKEAHA.111.639831

  3. Paolucci S, Iosa M, Toni D, et al. Prevalence and time course of post-stroke pain: A multicenter prospective hospital-based study. Pain Med. 2016;17(5):924-30. doi:10.1093/pm/pnv019

  4. Winstein CJ, Stein J, et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016 Jun;47(6):e98-e169. doi: 10.1161/STR.0000000000000098.

  5. Antoniello D, Kluger BM, Sahlein DH, Heilman KM. Phantom limb after stroke: An underreported phenomenon. Cortex. 2010;46(9):1114-22. doi:10.1016/j.cortex.2009.10.003

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.