Headache and Its Approach in Today’s NeuroIntensive Care Unit

Abstract

Headache is a very common symptom in the neurointensive care unit (neuroICU). While headache in the neuroICU can be caused by worsening of a pre-existing primary headache disorder, most are secondary to another condition. Additionally, headache can be the presenting symptom of a number of conditions requiring prompt recognition and treatment including subarachnoid hemorrhage, ischemic and hemorrhagic stroke, central nervous system infection, pituitary apoplexy, and cerebral vasoconstriction. The neuroICU also has a unique postoperative population in which postcraniectomy and postcraniotomy headache, postintravascular intervention headache, hyperperfusion syndrome, ventriculitis, medication overuse or withdrawal headache, and hypercapnia may be encountered. Management varies dramatically depending on the etiology of the headache. Overreliance on opiate analgesics may produce significant adverse effects and lengthen ICU stays. However, nonnarcotic medications are increasingly being recognized as helpful in reducing the pain among various postsurgical and headache patients. Taken together, a multimodal approach targeting the underlying pathology and choosing appropriate systemic and local analgesic medications may be the best way to manage headache in critically ill patients.

Migraine Headaches after Major Surgery with General or Neuraxial Anesthesia: A Nationwide Propensity-Score Matched Study

“…Second, our analyses have excluded patients who had a diagnosis of chronic migraine before surgery and therefore it is unclear whether types of anesthesia affect the precipitation of migraine headaches in this population. Third, surgeries that could only be performed with general anesthesia (e.g., brain surgery and ear, nose, and throat surgery) were excluded from analyses, which might decrease the generalizability of study results [ 32 ]. Fourth, a recent study reported that pre-existing migraine was a risk factor for postoperative nausea and vomiting [ 5 ].…”

“…( Supplementary Table S1 ) Since adverse events after surgery may produce physical and emotional stress and trigger migraine headaches [ 3 , 4 ], we also analyzed the major complications that occurred within 30 days after the index surgery, including pneumonia, septicemia, acute renal failure, pulmonary embolism, deep vein thrombosis, stroke, urinary tract infection, surgical site infection, acute myocardial infarction, cardiac dysrhythmias, and postoperative bleeding. Perioperative uses of blood transfusion [ 29 , 30 , 31 ] and need for intensive care [ 32 ] during the index surgical admission were analyzed. Our analyses also adjusted for the commonly used sympathomimetic drugs prescribed within 180 days after the index surgery, which might affect cerebral blood flow and modify migraine risk, including systemic corticosteroids, ephedrine, and theophylline [ 33 , 34 , 35 ].…”

The Impact of Surgery-Related Muscle Injury on Prevalence and Characteristics of Acute Postcraniotomy Headache – A Prospective Consecutive Case Series

“…3 Injury-related degranulation of calvarial and periosteal mast cells is likely to cause meningeal inflammation with subsequent activation of trigeminal and trigeminovascular nociceptive fibers. 12 Nerve entrapment or direct lesion with consecutive scar neuroma formation may build the basis for chronic neuropathic pain with allodynia and/or hyperalgesia at the site of incision in cases with chronic headache following craniotomy (e.g., occipital neuralgia due to occipital nerve injury in acoustic neuroma surgery via retrosigmoid approach). 20 21 Further possible contributing factors that have to be mentioned here are postsurgery pneumocephalus and perioperative disturbance of homeostasis because of hormonal-, stress-, sleep-, and nutrition-related alterations as well as caffeine and nicotine withdrawal.…”

“…We utilized our institutional postsurgery standard headache treatment algorithm, which was developed on an interdisciplinary basis with contributions from the departments of neurosurgery and anesthesiology/pain medicine, because to date there are no evidence-based consensus guidelines for the treatment of AHAC. 9 12 The institutional standard regimen for postcraniotomy pain relief is outlined in Fig. 1 .…”

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

“…ливающие препараты опиоидной группы. Кроме того, в литературе не рекомендуют применять нестероидные противовоспа-лительные средства при внутричерепных кровоизлияниях в связи с их влиянием на систему гемостаза и увеличением риска кро-вотечения [2]. Во второй группе из-за необходимости применения большего количества опиоидов случаи чрезмерной седации возникали чаще (-1-2 балла по Ричмондской шкале ажита-ции и седации у 30,2% больных второй груп-пы против 5,2% больных первой группы), что затрудняло своевременную оценку нев-рологического статуса.…”