TMS and Exercise for Post-stroke Pain

Inclusion Criteria: * Male or female Veteran of US military 19 years of age * Signed informed consent * Minimum of 3-months since time of stroke and medically stable * Headache has persisted for \>3 months after stabilization of the stroke * Ability to walk or tolerate recumbent cycle ergometry for 10 mins without assistance * Stable pain medication regimen for 1 month prior to study * Females of child-bearing potential (i.e. not postmenopausal or surgically sterile) must be using a medically acceptable method of birth control and should not be pregnant nor have plans for pregnancy or breastfeeding during the study * Completed diagnostic, maximal graded exercise test including 12-lead ECG and indirect calorimetry (i.e. oxygen uptake, minute ventilation, respiratory exchange ratio, etc.) * Minimum pain intensity of 30 on the Mechanical Visual Analogue Scale on average with pain symptoms. Exclusion Criteria: * Moderate to severe cognitive impairment (Montreal Cognitive Assessment score \<16/30) * Pre-stroke modified Rankin \>2 * History of seizures * Presence of any standard TMS or MRI contraindications (see human subjects) * Current diagnosis of DSM-5-defined bipolar disorder I, schizophrenia, schizoaffective disorder, or obsessive-compulsive disorder * Diagnosis of moderate or severe substance use disorder (except for caffeine and nicotine) during the preceding 3 months (Participants must agree to abstain from illicit drugs during the study) * Increased risk of suicide tha…