Study participants. The Strong Heart Family Study (SHFS, 2001-ongoing), a component of the Strong Heart Study (SHS, 1989-ongoing), is a multicenter, family-based prospective study designed to identify genetic factors for cardiovascular disease (CVD), T2D and their risk factors in American Indians. A total of 2,780 tribal members (≥18 years old) from 12 tribes residing in Arizona, North Dakota, South Dakota, and Oklahoma were initially examined in 2001-2003 and re-examined in 2006-2009 (mean 5.5 years apart) using the same protocols. At each visit,

Background: Severe headaches are common after subarachnoid hemorrhage (SAH). Guidelines recommend treatment with acetaminophen and opioids, but patient data show that headaches often persist despite multimodal treatment approaches. Considering an overall slim body of data for a common complaint affecting SAH patients during their intensive care stay, we set out to assess practice patterns in headache management among clinicians who treat patients with SAH.Methods: We conducted an international cross-sectional study through a 37-question web-based survey distributed to members of 5 professional societies relevant to intensive and neurocritical care from 11/2021-1/2022. Responses were characterized through descriptive analyses; Fisher's exact test was used to test associations.Results: Of 516 responses, 329/497 (66%) were from North America and 121/497 (24%) from Europe. 379/435 (87%) reported headache as major management concern for SAH patients. Intensive-care-teams were primarily responsible for analgesia during hospitalization (249/435, 57%), while responsibility shifted to neurosurgery at discharge (233/501, 47%). Most used medications were acetaminophen (90%), opioids (66%), corticosteroids (28%) and antiseizure medications (28%). Opioids or medication combinations including opioids were most frequently perceived as most effective, by 169/433 (39%, predominantly intensivists), followed by corticosteroids or combinations with corticosteroids (96/433, 22%, predominantly neurologists). Of medications prescribed at discharge, acetaminophen was most common (303/381, 80%), followed by opioids (175/381 [46%]), and antiseizure medications (173/381, 45%). Opioids during hospitalization were signi cantly more prescribed by intensivists, by providers managing higher numbers of SAH patients, and in Europe. At discharge, opioids were more frequently prescribed in North America. 299/435 (69%) indicated no change in prescription practice of opioids with the opioid crisis. Additional differences in prescription patterns between continents and providers, and inpatient versus discharge were found.Conclusions: Post-SAH headache in the intensive care setting is a major clinical concern. Analgesia heavily relies on opioids both in utilization and in perception of e cacy, with no reported change in prescription patterns for opioids for most providers despite the signi cant drawbacks of opioids.Responsibility for analgesia shifts between hospitalization and discharge. International and providerrelated differences are evident. Novel treatment strategies and alignment of prescription between providers are urgently needed.

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