Find out more about types of medication and surgery following a haemorrhagic stroke.

On this page

• Medication
• Surgery to treat subarachnoid haemorrhage (SAH)
• Other surgical procedures
• Treating seizures
• Treating headaches
• Rehabilitation

Medication

After a subarachnoid haemorrhage (SAH), the blood vessels in the brain can become narrowed in places, reducing the blood flow in the brain (vasospasm). This causes more stroke symptoms and can be very serious. Vasospasm can happen from around a day to three weeks after the stroke. To prevent it, you may be given a drug called nimodipine for about three weeks.

If you are taking warfarin or other blood-thinning medications (called direct oral anticoagulants), you may be given medication to reverse the effects.

If you have high blood pressure, you may be given medication to rapidly bring it down.

You will be offered painkillers to help with severe headache.

Surgery to treat subarachnoid haemorrhage (SAH)

SAH is often due to a burst aneurysm along a blood vessel that runs in the subarachnoid space. Surgery for SAH aims to stop the bleeding by sealing the weak area of blood vessel. The procedure used depends on how big the aneurysm is and where it’s located in the brain. Your doctors will discuss the options with you and explain the likely recovery times. If it’s an emergency procedure, they will use the method that works best for you and your stroke.

The main surgical procedures to repair a burst aneurysm are:

Coiling

A fine tube (catheter) is inserted into an artery in the groin and carefully steered up to the aneurysm near the brain. X-rays are used to guide the tube. Tiny platinum coils are passed through the tube and placed in the aneurysm. More coils are added until the aneurysm is sealed.

Clipping

Clipping involves removing a small flap of bone from the skull and using a tiny titanium clip to seal the aneurysm. After the clip is in place, the piece of bone is replaced and the scalp is stitched back together

Other surgical procedures

As well as surgery to repair aneurysms, other procedures can sometimes be used to deal with the impact of haemorrhagic stroke on the brain.

Procedure to relieve pressure on the brain (craniotomy and evacuation or hemicraniectomy)

If an intracerebral haemorrhage (ICH) is large, pressure can build up inside the skull due to bleeding or swelling of the brain. In some cases, surgery may be considered. Whether this will be of benefit depends on the size and location of the bleed, as well as your chances of making a good recovery.

A craniotomy is a surgical procedure where part of the skull is removed to allow the surgeon to access and remove the bleed. A hemicraniectomy is where a large piece of the skull on one side is removed, to reduce pressure on the brain.

External ventricular drain surgery for hydrocephalus (excess fluid in the brain)

Haemorrhagic stroke can sometimes lead to a dangerous build-up of fluid around the brain, known as hydrocephalus. This happens when the flow of cerebrospinal fluid that normally surrounds the brain and spinal cord is disrupted. Symptoms include headache and vomiting, as well as other stroke-like symptoms.

The main emergency treatment for hydrocephalus is an external ventricular drain, which is a thin tube implanted in the brain to drain the fluid away. An external ventricular drain is often removed once the hydrocephalus improves, but in some cases a shunt is used. A shunt is a tube that stays in and drains fluid to another part of the body. There is a valve attached, which you can feel under the skin on your scalp.

Treating seizures

Some people have a seizure after a haemorrhagic stroke. Having a seizure does not necessarily mean you will go on to develop epilepsy. You will be assessed to help decide the best treatment for you, which might include epilepsy medication, depending on your age and your risk of developing epilepsy.

Visit our seizures and epilepsy pages for more information.

Treating headaches after haemorrhagic stroke

While you are recovering from a haemorrhagic stroke or treatment such as surgery, you might have headaches which can often be treated with painkillers. Ask your doctor or pharmacist for advice about what type of painkillers you can use.

Some people also report strange sensations in their brain after an SAH, like running water or a tickling feeling on their brain. These are quite common and usually pass in time.

If you have a sudden, severe headache or a headache that does not go away, seek medical attention urgently.

Rehabilitation

You should receive rehabilitation therapy soon after your stroke if you have stroke-related problems. This should begin in hospital and carry on at home for as long as you need it. Rehabilitation is part of your recovery. It means trying to restore function to as near normal as possible, and helping you adapt if you have a disability.

You work with therapists to set goals, to help you with your recovery. Depending on the type of therapy, you may have exercises or activities to practice, to help you make progress. Practising exercises outside of therapy sessions can help you make progress.