• Cameron R Smith, W Christopher Fox, Christopher P Robinson, Cynthia Garvan, Marc-Alain Babi, Michael A Pizzi, Erica Lobmeyer, Alberto Bursian, Carolina B Maciel, and Katharina M Busl.
• Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
• Neurocrit Care. 2021 Aug 1; 35 (1): 241-248.

BackgroundSevere headache is a hallmark clinical feature of spontaneous subarachnoid hemorrhage (SAH), affecting nearly 90% of patients during index hospitalization, regardless of the SAH severity or presence of a culprit aneurysm. Up to 1 in 4 survivors of SAH experience chronic headaches, which may be severe and last for years. Data guiding the optimal management of post-SAH headache are lacking. Opioids, often in escalating doses, remain the guideline-recommended mainstay of acute therapy, but pain relief remains suboptimal.MethodsThis study is a case series of adult patients who received bilateral pterygopalatine fossa (PPF) blockade for the management of refractory headaches after spontaneous SAH (aneurysmal and non-aneurysmal) at a single tertiary care center. We examined pain scores and analgesic requirements before and after block placement.ResultsSeven patients (median age 54 years, 3 men, four aneurysmal and three non-aneurysmal) received a PPF-block between post-bleed day 6-11 during index hospitalization in the neurointensive care unit. The worst pain recorded in the 24-h period before the block was significantly higher than in the period 4 h after the block (9.1 vs. 3.1; p = 0.0156), and in the period 8 h after the block (9.1 vs. 2.8; p = 0.0313). The only complication was minor oozing from the needle insertion sites, which subsided completely with gauze pressure within 1 min.ConclusionsPPF blockade might constitute a promising opioid-sparing therapeutic strategy for the management of post-SAH headache that merits further prospective controlled randomized studies.© 2021. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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