• Elizabeth K Glisic, Linda Gardiner, Linda Josti, Elizabeth Dermanelian, Sandra Ridel, John Dziodzio, Barbara McCrum, Ben Enos, Patricia Lerwick, Gilles L Fraser, Paul Muscat, Richard R Riker, Robert Ecker, Jeffrey Florman, and David B Seder.
• 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.
• Am. J. Crit. Care. 2016 Mar 1; 25 (2): 136-43.

BackgroundHeadache profoundly affects management of spontaneous subarachnoid hemorrhage but is poorly characterized.ObjectiveTo characterize headache after spontaneous subarachnoid hemorrhage.MethodsMedical 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.ResultsOf 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.ConclusionsHeadache after spontaneous subarachnoid hemorrhage was often severe, necessitating multiple opioid and nonopioid analgesics. Many patients reported persistent headache and inadequate pain control.©2016 American Association of Critical-Care Nurses.

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