Inadequacy of Headache Management After Subarachnoid Hemorrhage.
Document Type
Article
Publication Date
3-1-2016
Institution/Department
Pharmacy; Nursing; Neurology and Neuroscience; Critical Care Medicine
Journal Title
American journal of critical care : an official publication, American Association of Critical-Care Nurses
MeSH Headings
Aged, Analgesics, Female, Headache, Humans, Male, Middle Aged, Pain Management, Subarachnoid Hemorrhage, Treatment Outcome
Abstract
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.
ISSN
1937-710X
First Page
136
Last Page
143
Recommended Citation
Glisic, Elizabeth K; Gardiner, Linda; Josti, Linda; Dermanelian, Elizabeth; Ridel, Sandra; Dziodzio, John; McCrum, Barbara; Enos, Ben; Lerwick, Patricia; Fraser, Gilles L; Muscat, Paul; Riker, Richard R; Ecker, Robert; Florman, Jeffrey; and Seder, David B, "Inadequacy of Headache Management After Subarachnoid Hemorrhage." (2016). MaineHealth Maine Medical Center. 752.
https://knowledgeconnection.mainehealth.org/mmc/752