title: Inadequacy of Headache Management After Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Headache profoundly affects management of spontaneous subarachnoid hemorrhage but is poorly characterized.
  
  
  OBJECTIVE
  To characterize headache after spontaneous subarachnoid hemorrhage.
  
  
  METHODS
  Medical records of patients with Hunt and Hess grades I-III subarachnoid hemorrhage admitted from 2011 to 2013 were reviewed. Demographics, clinical and radiographic features, medications, and pain scores were recorded through day 14 after hemorrhage. Headache pain was characterized on the basis of a numeric rating scale and analgesic use. Severe headache was defined as 2 or more days with maximum pain scores of 8 or greater or need for 3 or more different analgesics for 2 or more days. Univariate and multivariable models were used to analyze factors associated with severe headache.
  
  
  RESULTS
  Of the 77 patients in the sample, 57% were women; median age was 57 years. Severe headache (73% overall) was associated nonlinearly with Hunt and Hess grade: grade I, 58%; grade II, 88%; and grade III, 56% (P = .01), and with Hijdra score: score 0-10, 56%; score 11-20, 86%; score 21-30, 76% (P = .03). By univariate analysis, patients with low Hijdra scores were less likely to have severe headache (27% vs 57%; P = .02). In a multivariable model, younger age and higher Hijdra score tended to be associated with severe headache.
  
  
  CONCLUSIONS
  Headache after spontaneous subarachnoid hemorrhage was often severe, necessitating multiple opioid and nonopioid analgesics. Many patients reported persistent headache and inadequate pain control.
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center. glisie@mmc.org.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Glisic
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Linda
authors.initials: L
authors.lastname: Gardiner
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Linda
authors.initials: L
authors.lastname: Josti
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dermanelian
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ridel
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: John
authors.initials: J
authors.lastname: Dziodzio
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Barbara
authors.initials: B
authors.lastname: McCrum
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Ben
authors.initials: B
authors.lastname: Enos
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lerwick
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Gilles L
authors.initials: GL
authors.lastname: Fraser
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Paul
authors.initials: P
authors.lastname: Muscat
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Riker
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Robert
authors.initials: R
authors.lastname: Ecker
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Florman
authors.affiliation: Elizabeth K. Glisic and Gilles L. Fraser are clinical pharmacists in critical care and Ben Enos is a clinical pharmacist, Department of Pharmacy, Maine Medical Center, Portland, Maine. Linda Gardiner, Linda Josti, Elizabeth Dermanelian, and Sandra Ridel are neurocritical care nurses, Department of Nursing, Maine Medical Center. Barbara McCrum is a clinical research nurse coordinator, Neuroscience Institute, Maine Medical Center. John Dziodzio is a programmer/analyst and Patricia Lerwick is an intensivist physician, Department of Critical Care Services, Maine Medical Center. Paul Muscat is chief of neurology, Department of Medicine, Maine Medical Center. Robert Ecker and Jeffrey Florman are attending neurosurgeons, Neuroscience Institute, Maine Medical Center. Richard R. Riker is director of medical intensive care and David B. Seder is director of neurocritical care, Department of Critical Care Services, Maine Medical Center.
authors.forename: David B
authors.initials: DB
authors.lastname: Seder
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics