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 that necessitates inpatient treatment or warrants additional therapy excluded by the protocol; and/or intensity of suicidal ideation (Type 4 or Type 5) or any suicidal behavior in the past 3 months on Columbia Suicide Severity Rating Scale (C-SSRS) * Litigating for compensation for a psychiatric disorder * Veterans who are in the process of applying for or receiving VA service-connected disability are eligible * Current enrollment in another intervention trial for pain or stroke * Persons imprisoned, of minor age, diagnosed with terminal illness, or require surrogate for consent * Fails baseline exercise screening activities * Persistent post-stroke headaches not better accounted for by another diagnosis * Is unable to reliably attend intervention sessions i.e. planning to move, transportation issues * Neurological disorder pre- or post- stroke affecting subject's ability to follow study directions