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The Course of Headache in Patients With Moderate‐to‐Severe Headache Due to Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cross‐Sectional Study
Author(s) -
Hong ChangKi,
Joo JinYang,
Kim Yong Bae,
Shim Yu Shik,
Lim Yong Cheol,
Shin Yong Sam,
Chung Joonho
Publication year - 2015
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12612
Subject(s) - medicine , subarachnoid hemorrhage , modified rankin scale , headaches , vasospasm , glasgow coma scale , odds ratio , glasgow outcome scale , migraine , aneurysm , stroke (engine) , pediatrics , anesthesia , surgery , ischemic stroke , mechanical engineering , ischemia , engineering
Objectives The purpose of this study was to evaluate the course of headache in patients with moderate‐to‐severe headache due to aneurysmal subarachnoid hemorrhage ( aSAH ) and to identify its predisposing factors. Background Little is known about the long‐term course of headache in patients with aSAH . Methods Since S eptember 2009, patients with aSAH have had their headaches prospectively rated using a numeric rating scale ( NRS ). From this database containing 838 patients, 217 were included and all included patients met the following criteria: (1) presence of ruptured intracranial aneurysms on computed tomography angiography or magnetic resonance angiography; (2) alert consciousness ( G lasgow C oma S cale 15); (3) newly onset moderate‐to‐severe headache ( NRS ≥ 4) due to ruptured intracranial aneurysms; and (4) good clinical outcome at discharge (modified R ankin S cale 0, 1, or 2). We observed the changes in NRS scores from initial to 12‐month follow‐up and identified the predisposing factors of NRS changes. Results Of the 217 patients, 182 (83.9%) experienced improvement in NRS score ≤ 3 upon discharge. The NRS scores at discharge were significantly lower than those on admission ( P < .001). The independent predisposing factors for headache improvement included previous stroke (odds ratio [OR] = 0.141; 95% CI 0.051‐0.381; P < .001), previous headache treated with medication (OR = 0.079; 95% CI 0.010‐0.518; P = .008), and endovascular treatment ( EVT ; OR = 2.531; 95% CI 1.141‐5.912; P = .026). The NRS scores tended to decrease continuously until the 12‐month follow‐up. EVT and symptomatic vasospasm were independently associated with a decrease of NRS in the follow‐up periods. Conclusions The course of headache in patients with aSAH continuously improved during the 12 months of follow‐up. Headache improvement might be expected in patients who were treated with EVT and in those who did not have previous stroke or headache.