title: 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.
authors.affiliation: Departments of Neurology and Critical Care, Mayo Clinic, Jacksonville, FL, 32224, USA.
authors.forename: Laxmi P
authors.initials: LP
authors.lastname: Dhakal
authors.affiliation: Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Harriott
authors.affiliation: Department of Neurology, Mayo Clinic, Jacksonville, FL, 32224, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Capobianco
authors.affiliation: Departments of Neurology, Neurosurgery, and Critical Care, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. freeman.william1@mayo.edu.
authors.forename: William D
authors.initials: WD
authors.lastname: Freeman
mesh_terms: D002493:Central Nervous System Diseases / Q000150:complications*; D003422:Critical Care / Q000379:methods* / Q000592:standards; D051271:Headache Disorders, Secondary / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans
keywords: Headache; Headache management; Intensive care unit; Multimodal approach; Neurocritical care