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

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.