The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

Huckhagel, Torge; Klinger, Regine; Schmidt, Nils Ole; Regelsberger, Jan; Westphal, Manfred; Czorlich, Patrick

doi:10.1007/s00701-020-04235-7

Cited by 35 publications

(64 citation statements)

References 67 publications

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“…Anxiety and depression [ 11 , 17 , 18 ] are among the most investigated realms of patient outcome after aSAH with a stable prevalence over the 18-month period after aSAH and an estimated frequency ranging from 27 to 54% and from 5 to 50% in aSAH survivors, respectively [ 9 ]. Likewise, somatoform disorders, especially pain syndromes like cephalgia, are a commonly reported and oftentimes a long-lasting symptom burden after sSAH, plausibly affecting Ghp, poorer performance in several cognitive domains, and reduced hrQoL after sSAH [ 9 , 74 ]. In this context, the cerebral exposure to CGRP might reveal advanced insight and a potential therapeutic target in the future.…”

Section: Discussionmentioning

confidence: 99%

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

et al. 2020

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The vasodilatory calcitonin gene-related peptide (CGRP) is excessively released after spontaneous subarachnoid hemorrhage (sSAH) and modulates psycho-behavioral function. In this pilot study, we prospectively analyzed the treatment-specific differences in the secretion of endogenous CGRP into cerebrospinal fluid (CSF) during the acute stage after good-grade sSAH and its impact on self-reported health-related quality of life (hrQoL). Twenty-six consecutive patients (f:m = 13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out 19% (n = 5)): 35% (n = 9) underwent endovascular aneurysm occlusion, 23% (n = 6) microsurgery, and 23% (n = 6) of the patients with perimesencephalic SAH received standardized intensive medical care. An external ventricular drain was inserted within 72 h after the onset of bleeding. CSF was drawn daily from day 1–10. CGRP levels were determined via competitive enzyme immunoassay and calculated as “area under the curve” (AUC). All patients underwent a hrQoL self-report assessment (36-Item Short Form Health Survey (SF-36), ICD-10-Symptom-Rating questionnaire (ISR)) after the onset of sSAH (t1: day 11–35) and at the 6-month follow-up (t2). AUC CGRP (total mean ± SD, 5.7 ± 1.8 ng/ml/24 h) was excessively released into CSF after sSAH. AUC CGRP levels did not differ significantly when dichotomizing the aSAH (5.63 ± 1.77) and pSAH group (5.68 ± 2.08). aSAH patients revealed a higher symptom burden in the ISR supplementary item score (p = 0.021). Multiple logistic regression analyses corroborated increased mean levels of AUC CGRP in CSF at t1 as an independent prognostic factor for a significantly higher symptom burden in most ISR scores (compulsive-obsessive syndrome (OR 5.741, p = 0.018), anxiety (OR 7.748, p = 0.021), depression (OR 2.740, p = 0.005), the supplementary items (OR 2.392, p = 0.004)) and for a poorer performance in the SF-36 physical component summary score (OR 0.177, p = 0.001). In contrast, at t2, CSF AUC CGRP concentrations no longer correlated with hrQoL. To the best of our knowledge, this study is the first to correlate the levels of endogenous CSF CGRP with hrQoL outcome in good-grade sSAH patients. Excessive CGRP release into CSF may have a negative short-term impact on hrQoL and emotional health like anxiety and depression. While subacutely after sSAH, higher CSF levels of the vasodilator CGRP are supposed to be protective against vasospasm-associated cerebral ischemia, from a psychopathological point of view, our results suggest an involvement of CSF CGRP in the dysregulation of higher integrated behavior.

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Section: Discussionmentioning

confidence: 99%

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

et al. 2020

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“…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%

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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“…If anything, even less is known regarding the epidemiology, clinical characteristics and potential treatment for headache persisting after non-traumatic SAH or ICH. In one prospective single-center study, 41% of 93 patients surviving aneurysmal SAH reported “burdensome” headache at a mean follow-up of just under 3 years (85). Persistent headache correlated with younger mean age and, despite more favorable neurologic status, lower health-related quality of life scores relative to patients free of chronic headache.…”

Section: Special Circumstances and Considerationsmentioning

confidence: 99%

“…In a study involving 90 survivors of non-traumatic ICH, 11% reported the new onset of persistent headache following the hemorrhage; there appeared to be an association with depression (86). Somewhat at odds with the ICHD-3 criteria for 6.2.4.1, the authors noted that “there was usually a delay of weeks or months between ICH and the first headache episode” (86).…”

Section: Special Circumstances and Considerationsmentioning

confidence: 99%

Headache secondary to cerebrovascular disease

Rothrock

Diener

2021

Cephalalgia

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Objectives To discuss headache secondary to cerebrovascular disease. Background Headache is an important symptom in cerebrovascular diseases. In some conditions, headache is the leading symptom. Migraine is associated with an increased risk of stroke. Methods The authors undertook a literature search for the terms “headache” and “cerebrovascular diseases”. Results We report studies on headache in subarachnoidal hemorrhage, intracerebral hemorrhage, ischemic stroke, TIA, basilar artery thrombosis, cervical artery dissection, cerebellar stroke, arteritis and cerebral sinus venous thrombosis. In addition, we discuss migraine and stroke and thunderclap headache. Conclusions Headache is a leading symptom in many cerebrovascular diseases. Headache in combination with focal neurological deficits requires immediate diagnosis and treatment.

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The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis

Cited by 35 publications

References 67 publications

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

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

Headache secondary to cerebrovascular disease

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