6.1.1.2 Persistent headache attributed to past ischaemic stroke (cerebral infarction)

Identification: Female patient, 58 years old, with a history of ischemic stroke in the left middle cerebral artery territory (4 months ago), hypertensive and dyslipidemic.

History of Present Illness:
Reports daily headache, described as a heaviness or pressure, in the left frontotemporal region, with moderate intensity (5-6/10), since the stroke event. Worsens with physical exertion or stress, without nausea, photophobia, or phonophobia. Does not respond adequately to common analgesics (paracetamol, NSAIDs). No new neurological deficits since the previous stroke.

Physical/Neurological Examination:
Sequelae of previous stroke: Mild expressive dysphasia and residual paresis in the right upper limb (4/5). Stable neurological examination, without new focal signs. Current NIHSS: 2 (only due to residual deficit).

Complementary Exams:
Post-stroke cranial CT: Chronic ischemic lesion in the left MCA territory (encephalomalacia). Current brain MRI: No new infarcts or acute lesions. Cervical vessel MR angiography: Moderate atherosclerosis of the left internal carotid artery (stenosis <50%).