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13.13.2 Central post-stroke pain (CPSP)


Usually unilateral facial and/or head pain, with varying presentations involving parts or all of the craniocervical region and associated with impaired sensation, occurring within 6 months of and caused by stroke. It is not explicable by a lesion of the peripheral trigeminal or other cranial or cervical nerves.

Diagnostic criteria:
  1. Facial and/or head pain fulfilling criterion C
  2. Ischaemic or haemorrhagic stroke has occurred
  3. Evidence of causation demonstrated by both of the following:
    1. pain has developed within 6 months after the stroke
    2. imaging1 has demonstrated a vascular lesion in an appropriate site
  4. Not better accounted for by another ICHD-3 diagnosis.

Usually MRI.


13.13.2 Central post-stroke pain is attributed to a lesion of the ascending projections of the trigeminal nuclei. Cervical spinothalamic pathways and cortical processing may also play significant roles. Therefore, symptoms may also involve the trunk and limbs of the affected side.

Craniocervical pain following a thalamic lesion is part of a hemisyndrome. With lateral medullary lesions, hemifacial pain may occur in isolation but is more often accompanied by crossed hemidysaesthesia.