Inadequacy of headache management after subarachnoid hemorrhage.

Document Type


Publication Date



Pharmacy, Nursing

Journal Title

American Journal of Critical Care

MeSH Headings

Headache Drug Therapy; Subarachnoid Hemorrhage Complications; Pain Measurement; Demography; Headache Epidemiology; Prevalence; Analgesics Administration and Dosage; Clinical Assessment Tools; Scales; Retrospective Design; Descriptive Statistics; Chi Square Test; Logistic Regression; Data Analysis Software; P-Value; Middle Age; Aged; Female; Male; Human; Middle Aged: 45-64 years; Aged: 65+ years; Female; Male


Background Headache profoundly affects management of spontaneous subarachnoid hemorrhage but is poorly characterized. Objective To characterize headache after spontaneous subarachnoid hemorrhage. Methods Medical records of patients with Hunt and Hess grades I-III subarachnoid hemorrhage admitted from 2011 to 2013 were reviewed. Demographics, clinical and radiographic features, medications, and pain scores were recorded through day 14 after hemorrhage. Headache pain was characterized on the basis of a numeric rating scale and analgesic use. Severe headache was defined as 2 or more days with maximum pain scores of 8 or greater or need for 3 or more different analgesics for 2 or more days. Univariate and multivariable models were used to analyze factors associated with severe headache. Results Of the 77 patients in the sample, 57% were women; median age was 57 years. Severe headache (73% overall) was associated nonlinearly with Hunt and Hess grade: grade I, 58%; grade II, 88%; and grade III, 56% (P = .01), and with Hijdra score: score 0-10, 56%; score 11-20, 86%; score 21-30, 76% (P = .03). By univariate analysis, patients with low Hijdra scores were less likely to have severe headache (27% vs 57%; P = .02). In a multivariable model, younger age and higher Hijdra score tended to be associated with severe headache. Conclusions Headache after spontaneous subarachnoid hemorrhage was often severe, necessitating multiple opioid and nonopioid analgesics. Many patients reported persistent headache and inadequate pain control.

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