Abstract Details

Title Severe Headache Trajectory Following Aneurysmal Subarachnoid Hemorrhage: The Association with Lower Sodium Levels

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 362

Objective To characterize the severity and trajectory of headaches in relation to clinical features of aneurysmal subarachnoid hemorrhage (aSAH) patients.

Background One of the clinical hallmarks of aSAH is headache, which is nearly universal. However, post-aSAH headache characterization has been limited, and little is known about factors that may point to underlying mechanisms.

Design/Methods This is a retrospective longitudinal study of adult patients admitted to an academic tertiary care center between 2012-2019 with aSAH who could verbalize pain intensity scores (on the 11-point numeric rating scale). Additional factors included demographics, aneurysm characteristics, analgesia, daily morning serum sodium concentration, and occurrence of radiographic vasospasm. Group-based trajectory modeling was used to identify headache pain trajectories, and clinical factors were compared between trajectories using T test, chi-squared test, or Wilcoxon rank signed test. Trajectories were further examined with linear regression.

Results

Of 91 patients included in the analysis, the mean age was 57 years and 20 (22%) were male. Headache score trajectories clustered into two groups: patients with mild-moderate pain and patients with moderate-severe pain. Patients in the moderate-severe pain group were younger (54.35 ± 1.75 vs 63.44 ± 3.14 years, P<0.05), received more opioid analgesia (24.36 ± 3.73 vs 15.18 ± 6.06 oral morphine equivalents, P<0.001), and had lower sodium concentrations (137.5 ± 0.3 vs 139.3 ± 0.5, P<0.001) than patients in the mild-moderate pain group.

Conclusions In this study of headache after aSAH, we identified two distinct pain trajectory cohorts (mild-moderate and moderate-severe) and an association of these trajectories with age, analgesia, and sodium levels. Future multi-institutional prospective studies focusing on headache trajectories and phenotypes that account for standardized analgesic regimens, sodium homeostasis, and optimized volume status are needed.

Authors/Disclosures
Robert S. Eisinger, MD, PhD PRESENTER	The institution of Dr. Eisinger has received research support from NIH.
	No disclosure on file
Brandon Lucke-Wold	Mr. Lucke-Wold has nothing to disclose.
Sonya E. Zhou, MD (Hospital of the University of Pennsylvania)	Sonya Zhou has nothing to disclose.
	No disclosure on file
	No disclosure on file
Carolina B. Maciel, MD, MSCR, FAAN	Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health.
Katharina M. Busl, MD, MS, FAAN (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Huffman Powell Baley. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University Science. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SCCM. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to AAN interests or activities.

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