ABSTRACT NUMBER: ESOC2026LB27 LONG-TERM HEADACHE FOLLOWING CEREBRAL VENOUS THROMBOSIS: A SYSTEMATIC REVIEW

Abstract Background and aims Cerebral venous thrombosis (CVT) affects young adults and frequently presents with headache. Although functional outcomes are generally favorable, many patients report persistent or recurrent headache long after the acute event. This systematic review aimed to assess the prevalence, clinical characteristics, associated factors, and management of long-term headache following CVT. Methods A systematic review was performed using PubMed and Embase (2000–2025). Studies reporting original data on long-term headache following CVT in adult populations were eligible for inclusion. Case series with fewer than 30 patients were excluded. Owing to heterogeneity in study designs, definitions, and outcome measures, a qualitative narrative synthesis was performed. Results Fifteen studies comprising 2,136 patients were included. The reported prevalence of post-CVT headache ranged from 14% to 59%. Headache most commonly resembled primary headache disorders, particularly tension-type and migraine-like phenotypes. Pre-existing headache disorders and depression were associated with post-CVT headache, whereas intracerebral hemorrhage was not. Associations with venous recanalization, thrombosis location, and anticoagulation delay were inconsistent. Secondary mechanisms, such as intracranial hypertension, dural arteriovenous fistula, CVT recurrence, and medication-overuse headache, were identified in some patients. Management strategies were poorly reported. Conclusions Long-term headache is a frequent but under-recognized complication of CVT with potential impact on quality of life. The absence of a standardized definition contributes to heterogeneous reporting. We suggest consideration of a new International Classification of Headache Disorders entity, such as a new or modified recurrent headache attributed to past CVT. Prospective studies using standardized headache assessments are needed to optimize management. Conflict of interest