The chronic pain and unsightly rash of shingles is bad enough, but now there’s increasing evidence that you’re at much higher risk for stroke in the first few weeks following the onset of a shingles attack. Protect yourself by knowing which shingles symptom is most associated with stroke and how you can lower your risk for shingles and shingles-related stroke.


Shingles, also known as herpes zoster, is caused by varicella zoster virus (VZV)—the same virus that causes chicken pox. Decades after infection, when a person’s immune system is weakened by age, disease or medications, the virus can reactivate. Shingles’ main symptoms are shooting pain, burning, numbness, itchiness and a rash and blisters on one side of the body, which usually last about two weeks but can become chronic.

Shingles usually affects the skin, but the virus can also affect blood vessels, the brain, eyes and spinal cord, leading to inflammation of the brain (encephalitis), inflammation of the membranes around the spinal cord and brain (meningitis), blindness or stroke. The new study examined more than 6,500 patients and showed that the risk for stroke increased by 63% during the first month following the first symptoms of shingles. The increased risk gradually lessened—to 42% during the second and third months and to 23% during months four through six.

One specific form of shingles greatly increased stroke risk. Herpes zoster ophthalmicus (HZO)—where the shingles rash occurs around one or both eyes—turned out to be a telltale risk factor for stroke in the study. Patients with HZO had a greater than three-fold increased risk for stroke. That’s because HZO is a sign that the herpes virus has reactivated from a cluster of neurons in the head called the trigeminal ganglia. “When the virus reactivates here, it not only travels along nerve fibers that go straight to the area around the eye, but also has potential to travel along nerve fibers directly to blood vessels in the brain,” explained Maria Nagel, MD, a specialist in viral infections of the nervous system who provided expert commentary that accompanied the study.


Getting the shingles vaccine (Zostavax) is no guarantee that you won’t get shingles, but it does cut your risk in half. The US Centers for Disease Control and Prevention recommends the vaccine for adults 60 years of age and older, but it is FDA-approved for anyone over 50.

The vaccine is not recommended for every older adult. Avoid it if you…

• Are allergic to gelatin, the antibiotic neomycin or any other component of the vaccine.

• Have a weakened immune system, either due to a medical condition such as diabetes, kidney failure, sickle-cell anemia, cirrhosis or HIV infection…because you are receiving treatments that modify or suppress your immune system such as chemotherapy or radiation or are on immunosuppressive therapies for an autoimmune disease such as rheumatoid arthritis, multiple sclerosis and Crohn’s disease…or take certain medications including corticosteroids, infliximab (Remicade), adalimumab (Humira) and etanercept (Enbrel).


If you do get shingles, even after vaccination, take action. Antiviral therapy such as acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir) not only relieves symptoms, but can lower your risk for stroke. In the study on stroke and shingles, patients who were treated with antiviral therapy for shingles were still at increased stroke risk but at a much lower rate—28%—than patients who did not receive antiviral therapy.

“I treat all my shingles patients with a full two-week course of antiviral therapy, taking into consideration their kidney function and any medical conditions that need to be monitored while on antiviral therapy,” said Dr. Nagel. “The rash usually resolves within two weeks or less if antivirals are used, but pain can persist for up to three months.”

If you haven’t already been vaccinated for shingles, this study is a good reason to stop procrastinating. If shingles does happen to erupt, discuss antiviral therapy with your doctor instead of just toughing it out—especially if you develop a rash around your eyes. Also, be on the lookout for strokelike symptoms, such as drooping or numbness on one side of the face, weakness or numbness in an arm or leg, slurred speech or sudden loss or dimness of vision, in the first few months after a shingles outbreak. If these occur, seek urgent medical care and be sure to let your doctor know about your recent history of shingles.