title: The Course of Headache in Patients With Moderate-to-Severe Headache Due to Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cross-Sectional Study.
abstract: OBJECTIVE
  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 September 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 (Glasgow Coma Scale 15); (3) newly onset moderate-to-severe headache (NRS ≥ 4) due to ruptured intracranial aneurysms; and (4) good clinical outcome at discharge (modified Rankin Scale 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.
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.|Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Hong
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jin-Yang
authors.initials: JY
authors.lastname: Joo
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine and Hospital, Incheon, South Korea.
authors.forename: Yu Shik
authors.initials: YS
authors.lastname: Shim
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine and Hospital, Suwon, South Korea.
authors.forename: Yong Cheol
authors.initials: YC
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, , College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Yong Sam
authors.initials: YS
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.|Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Joonho
authors.initials: J
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis; D002533:Cerebral Angiography; D003430:Cross-Sectional Studies; D057510:Endovascular Procedures; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult
keywords: headache; intracranial aneurysm; subarachnoid hemorrhage