Evaluation of headache severity after aneurysmal subarachnoid hemorrhage

Swope, Rachel; Glover, Kelly; Gokun, Yevgeniya; Fraser, Justin F.; Cook, Aaron M.

doi:10.1016/j.inat.2014.07.003

Cited by 18 publications

(25 citation statements)

References 12 publications

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“…This analysis characterized previously unrecognized trajectories in pain following SAH. Prior studies of the longitudinal course of headache following SAH have either found headache to demonstrate increasing severity over the first 7 days, similar to our group 3 [ 6 ], or be severe and persistent during the first 14 days [ 4 , 5 ]. This study is the first to decipher distinct pain trajectories for different patient groups.…”

Section: Discussionsupporting

confidence: 82%

“…Subarachnoid hemorrhage (SAH) classically presents with a headache described as the worst of life [ 1 ]. Research efforts have focused on improving functional neurologic outcomes and mortality after SAH, but the characterization of pain after SAH has received less attention [ 2 – 6 ]. The few studies available concur that the headache following SAH is severe but have found disparate results regarding the temporal course of pain during the acute hospitalization [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Research efforts have focused on improving functional neurologic outcomes and mortality after SAH, but the characterization of pain after SAH has received less attention [ 2 – 6 ]. The few studies available concur that the headache following SAH is severe but have found disparate results regarding the temporal course of pain during the acute hospitalization [ 4 – 6 ]. Similar to other conditions associated with severe acute pain, SAH is associated with high rates of long-term opioid use [ 7 , 8 ], a fact made more salient by the fact that the current opioid crisis in the United States is in part driven by opioid prescriptions for acute medical conditions [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

et al. 2021

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Background Subarachnoid hemorrhage (SAH) is characterized by the worst headache of life and associated with long-term opioid use. Discrete pain trajectories predict chronic opioid use following other etiologies of acute pain, but it is unknown whether they exist following SAH. If discrete pain trajectories following SAH exist, it is uncertain whether they predict long-term opioid use. We sought to characterize pain trajectories after SAH and determine whether they are associated with persistent opioid use. Methods We reviewed pain scores from patients admitted to a single tertiary care center for SAH from November 2015 to September 2019. Group-based trajectory modeling identified discrete pain trajectories during hospitalization. We compared outcomes across trajectory groups using χ 2 and Kruskal–Wallis tests. Multivariable regression determined whether trajectory group membership was an independent predictor of long-term opioid use, defined as continued use at outpatient follow-up. Results We identified five discrete pain trajectories among 305 patients. Group 1 remained pain free. Group 2 reported low scores with intermittent spikes and slight increase over time. Group 3 noted increasing pain severity through day 7 with mild improvement until day 14. Group 4 experienced maximum pain with steady decrement over time. Group 5 reported moderate pain with subtle improvement. In multivariable analysis, trajectory groups 3 (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.5–8.3) and 5 (OR 8.0; 95% CI 3.1–21.1), history of depression (OR 3.6; 95% CI 1.3–10.0) and racial/ethnic minority (OR 2.3; 95% CI 1.3–4.1) were associated with continued opioid use at follow-up (median 62 days following admission, interquartile range 48–96). Conclusions Discrete pain trajectories following SAH exist. Recognition of pain trajectories may help identify those at risk for long-term opioid use.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

et al. 2021

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“…Acute aneurysmal subarachnoid hemorrhage (aSAH) is a catastrophic event presenting with excruciating headache often described as a “thunderclap headache.” The origin of this pain is thought to be neuropathic as the meninges which are innervated by the branches of the trigeminal nerve are inflamed as a consequence of exposure to blood, resulting in meningism, causing severe headache. 1 2 3 4 5 in this subset of patients, control of pain is of paramount importance as severe pain results in the activation of the sympathetic system, resulting an increase in the blood pressure and an increase in the level of stress hormones. 6 7 This, in turn, increases the chance of complications, such as rerupture/rebleed, vasospasm, and stress cardiomyopathy which are associated with greater morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Effect of Pregabalin on Perioperative Headache in Patients with Aneurysmal Subarachnoid Hemorrhage: A Randomized Double-Blind, Placebo-Controlled Trial

Lionel

Sethuraman

Abraham

et al. 2019

Journal of Neurosciences in Rural Practice

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Background Patients with acute aneurysmal subarachnoid hemorrhage (aSAH) experience excruciating headache that is difficult to manage in resource-constrained settings. Pregabalin’s (β-isobutyl-GABA) analgesic, antiepileptic, and antiemetic properties make it an attractive adjuvant in pain management for these patients. Methods We conducted a double-blind, placebo-controlled, randomized clinical trial on 40 aSAH patients undergoing aneurysmal clipping to assess the effect of perioperative pregabalin in decreasing perioperative headache, anesthetic, and opioid requirement. Patients received either pregabalin (75 mg) or placebo twice daily soon after admission till 24-hour postoperative, in addition to paracetamol 650 mg thrice daily. Headache assessed using a visual analog scale (VAS) at five time points was compared using a mixed effects regression model. Results Pain assessed by VAS declined significantly more from the baseline in pregabalin recipients compared with placebo at preinduction (–3.6 vs.–1.8; p = 0.004), 12-hour (4.3 vs. 2.8; p = 0.014), and 24-hour postsurgery (4.7 vs. 2.9; p = 0.007), but not at the 6-hour postoperation (4.9 vs. 3.8; p = 0.065). Pregabalin recipients required a lower minimum alveolar concentration of sevoflurane to maintain a prespecified bispectral index of 40 and 60 (0.8 vs. 0.9; p = 0.014) and required fewer rescue analgesic doses in the 24 hours following surgery (1.8 vs. 3.3; p = 0.005). The intraoperative fentanyl requirement was not significantly different between the groups (10 μg/kg vs. 11.4 μg/kg; p = 0.065). There was no significant difference in the sedation scores. Conclusions Pregabalin 75 mg administered twice daily, during the perioperative period, was an effective adjunct in the management of the severe headache experienced by patients with aSAH and decreased the opioid and anesthetic requirement without significantly increasing sedation.

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“…В доступной литературе по данной теме хорошо описаны характеристики головной боли, но в отношении оценки лечения сущес-твует нехватка доказанных данных [5,7].…”

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Experience of headache treatment in acute non-traumatic subarachnoid hemorrhage and evaluation of treatment effectiveness

et al. 2016

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Aim. Assessment of approaches to the identification and treatment of headache in acute non-traumatic subarachnoid hemorrhage for further study of this problem and optimization of analgesic therapy.Methods. Medical records of 62 patients admitted to the hospital with acute non-traumatic subarachnoid hemorrhage (SAH) were retrospectively reviewed. The patients were divided into 2 groups: 19 patients underwent X-ray guided endovascular occlusion under local anesthesia and 43 patients had their aneurysm clipped under general anesthesia. Quantitative assessment of headache with the use of Visual Analog Scale (VAS) and qualitative assessment using McGill Pain Questionnaire were performed in all patients. Non-steroidal anti-inflammatory drugs (dexketoprofen, paracetamol) and opioid analgesics were used for analgesia.Results. It was found that the wide-spread approach to the relief of headaches in SAH is not effective enough that is especially evident from the results of the second group (average VAS score in group 1 was 4.7±2.9 versus 6.3±1.8 in group 2). Achieving adequate analgesia with opioids was accompanied with excessive sedation (Richmond Agitation-Sedation Scale score was -1-2 points) complicating timely evaluation of neurological status. McGill Pain Questionnare data received and insufficient effect of the used treatment regimen allow us to suggest presence of neuropathic component of headache in non-traumatic subarachnoid hemorrhage.Conclusion. Conventional methods and regimens of headache treatment are not effective enough so it is necessary to analyze protocol variants for headache evaluation and adequate treatment regimens considering pathogenetic mechanisms of pain in non-traumatic subarachnoid hemorrhage and the possibility of excessive sedation with opioid analgesics.

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Evaluation of headache severity after aneurysmal subarachnoid hemorrhage

Cited by 18 publications

References 12 publications

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

Effect of Pregabalin on Perioperative Headache in Patients with Aneurysmal Subarachnoid Hemorrhage: A Randomized Double-Blind, Placebo-Controlled Trial

Experience of headache treatment in acute non-traumatic subarachnoid hemorrhage and evaluation of treatment effectiveness

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