Inadequacy of Headache Management After Subarachnoid Hemorrhage

Glisic, Elizabeth; 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 D.; Florman, Jeffrey E.; Seder, David B.

doi:10.4037/ajcc2016486

Cited by 45 publications

(43 citation statements)

References 29 publications

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“…Third, chronic headache following the initial bleeding was reported to be present in up to one-third of patients and affecting daily routine in more than half of those patients. Several studies suggested different regimes of pain management during acute treatment [32,33]. Regarding the long-term frequency of headache, there were only descriptive data available which described rates between 12% and 25% [26,34].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Complications and Influence on Outcome in Patients Surviving Spontaneous Subarachnoid Hemorrhage

et al. 2020

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Background: While the short-term clinical outcome of patients with subarachnoid hemorrhage (SAH) is well described, there are limited data on long-term complications and their impact on social reintegration. This study aimed to assess the frequency of complications post-SAH and to investigate whether these complications attribute to functional and self-reported outcomes as well as the ability to return to work in these patients. Methods: This retrospective single-center study included patients with atraumatic SAH over a 5-year period at a tertiary care center. Patients received a clinical follow-up for 12 months. In addition to demographics, imaging data, and parameters of acute treatment, the rate and extent of long-term complications after SAH were recorded. The functional outcome was assessed using the modified Rankin Scale (mRS; favorable outcome defined as mRS = 0-2). Further outcomes comprised self-reported subjective health measured by the EQ-5D and return to work for Gerner et al.

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Section: Discussionmentioning

confidence: 99%

Long-Term Complications and Influence on Outcome in Patients Surviving Spontaneous Subarachnoid Hemorrhage

et al. 2020

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“…Opioids are typically used for the management of aSAH-related pain in the hospital, and are frequently prescribed at discharge ( 5 ). Recently, the National Academies of Science and National Institutes of Health have raised awareness about the current public health crisis of misuse and addiction to opioids, and advise reducing opioid prescription when feasible ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Safety, Tolerability, and Efficacy of Pain Reduction by Gabapentin for Acute Headache and Meningismus After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

et al. 2020

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Introduction: Severe, often sudden-onset headache is the principal presenting symptoms of aneurysmal subarachnoid hemorrhage (aSAH). We hypothesized that gabapentin would be safe and tolerable for aSAH-induced headaches and would reduce concurrent opioid use. Methods: We performed a single-center, double-blind, randomized, placebo-controlled trial (registered at ClinicalTrials.gov; NCT02330094) from November 24, 2014, to June 24, 2017, where aSAH patients received either dose-escalating gabapentin or oral placebo, both alongside a standard of care pain regimen. After 7 days, patients had the option to continue in an open-label period until 14 days after enrollment or until discharge from the intensive care unit. Our primary endpoint was the efficacy of gabapentin in reducing headache numeric pain scores and opioid usage in patients with aSAH compared to the placebo group. We identified 63 potential patients with aSAH for the study. After applying stringent exclusion criteria, 16 eligible patients were enrolled into one of two arms. Results: The study ended prematurely after reaching a pre-specified funding period and an unexpected drop in aSAH cases. There was a trend toward lower headache numeric pain scores and opioid use in the gabapentin treated arm; however this was not significantly different. Gabapentin was well tolerated by participants and no adverse effects were reported. Conclusions: While there was a trend toward lower pain scores and opioid requirement in the gabapentin group, the study was underpowered to detect a difference. Larger multicenter trials are required to evaluate the efficacy of gabapentin to reduce opioid requirements after aSAH.

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“…[11][12][13] Similarly, patients with vascular malformations and/or cerebral aneurysms were excluded as they tend to require more postoperative analgesia to achieve pain control compared with their tumor counterparts. 15 Associated cerebral vasospasm and hydrocephalus may also introduce considerable heterogeneity. [16][17][18][19] Thus, the objectives of this systematic review were: (1) to compare the effectiveness of non-opioid and opioid analgesia in the treatment of post-craniotomy pain and (2) to identify available options for opioid-free analgesia postcraniotomy and consider clinical pathways for their effective use.…”

Section: Introductionmentioning

confidence: 99%

Opioid-Free Analgesia for Supratentorial Craniotomies: A Systematic Review

Darmawikarta

Sourour

Couban

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:Background: Post-craniotomy pain can be severe and is often undermanaged. Opioids can interfere with neurological monitoring and are associated with adverse effects. This systematic review aimed to identify measures of opioid-free analgesia and compare their effectiveness with opioid analgesia for post-craniotomy pain in patients with supratentorial tumors. Methods: EMBASE, MEDLINE, and Cochrane databases were searched from their inception to February 14, 2017, for randomized controlled trials (RCTs) evaluating opioid versus non-opioid analgesia post-supratentorial craniotomy. Two reviewers independently carried out study selection and data extraction. Risk of bias assessment was performed using the Cochrane Collaboration’s tool. Outcomes were pain control (changes to pain scores or use of rescue analgesia) and adverse effects. Considering the number of studies and heterogeneity, a narrative synthesis was done without pooling and results were summarized using tables. Non-opioids were assessed for the potential to be equivalent to opioid-based analgesics for pain relief and adverse effects. Results: Of 467 RCTs, 4 met our inclusion criteria (n = 186 patients). Patients with scalp blocks (2 RCTs) had less post-operative nausea and vomiting (PONV), but scalp block was not superior to morphine for analgesia. Acetaminophen (1 RCT) was less likely to induce PONV but provided inadequate pain relief compared to morphine and sufentanil. Dexmedetomidine (1 RCT) was not superior to remifentanil for analgesia although it delayed time to rescue analgesia. Conclusions: Limited evidence suggests that scalp blocks and dexmedetomidine have the potential to eliminate the need for opioid analgesia. Multimodal analgesia should be considered as significant opioid-sparing effects have been shown.

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Inadequacy of Headache Management After Subarachnoid Hemorrhage

Cited by 45 publications

References 29 publications

Long-Term Complications and Influence on Outcome in Patients Surviving Spontaneous Subarachnoid Hemorrhage

Long-Term Complications and Influence on Outcome in Patients Surviving Spontaneous Subarachnoid Hemorrhage

Safety, Tolerability, and Efficacy of Pain Reduction by Gabapentin for Acute Headache and Meningismus After Aneurysmal Subarachnoid Hemorrhage: A Pilot Study

Opioid-Free Analgesia for Supratentorial Craniotomies: A Systematic Review

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