Changes in Resting-State Connectivity After rTMS and Exercise in Persons with Post-Stroke Headache Pain

Chronic post-stroke headache is a common yet understudied complication of stroke, potentially driven by maladaptive connectivity between limbic and sensorimotor brain regions. This pilot study evaluated the effects of a combined intervention using repetitive transcranial magnetic stimulation (rTMS) and moderate-intensity exercise on resting-state functional connectivity and self-reported pain outcomes in individuals with persistent post-stroke headache. Five participants completed ten sessions of rTMS targeted to the primary motor cortex followed by aerobic exercise within a 2 h window. Resting-state fMRI and behavioral data were collected at baseline and post-intervention. Seed-based analyses revealed reduced connectivity between the amygdala, insula, and thalamus and regions involved in salience, sensory, and cognitive control. Self-reported pain severity and interference (Brief Pain Inventory [BPI] and Visual Analogue Scale [VAS]) also showed mean reductions over the course of the study. These findings support the feasibility and potential neural and behavioral impact of combined neuromodulatory and behavioral interventions for managing chronic pain after stroke.