Severe headache trajectory following aneurysmal subarachnoid hemorrhage: the association with lower sodium levels

ABSTRACT

Background

A clinical hallmark of aneurysmal SAH (aSAH) is headache. Little is known about post-aSAH headache factors which may point to underlying mechanisms. In this study, we aimed to characterize the severity and trajectory of headaches in relation to clinical features of patients with aSAH.

Methods

This is a retrospective longitudinal study of adult patients admitted to an academic tertiary care center between 2012 and 2019 with aSAH who could verbalize pain scores. Factors recorded included demographics, aneurysm characteristics, analgesia, daily morning serum sodium concentration, and occurrence of vasospasm. Group-based trajectory modeling was used to identify headache pain trajectories, and clinical factors were compared between trajectories.

Results

Of 91 patients included in the analysis, mean age was 57 years and 20 (22%) were male. Headache score trajectories clustered into two groups: patients with mild-moderate and moderate-severe pain. Patients in the moderate-severe pain group were younger (P<0.05), received more opioid analgesia (P<0.001), and had lower sodium concentrations (P<0.001) than patients in the mild-moderate pain group.

Conclusion

We identified two distinct post-aSAH headache pain trajectory cohorts and identified an association with age, analgesia, and sodium levels. Future prospective studies considering sodium homeostasis and volume status under standardized analgesic regimens are warranted.

KEYWORDS:

• Aneurysmal subarachnoid hemorrhage
• headache
• vasospasm
• sodium
• hyponatremia
• SIADH
• opioids

Acknowledgements

All coauthors have reviewed and approve of the content of this manuscript. The requirements for authorship have been met. This submission is not under review by any other publication. We confirm adherence to ethical guidelines with IRB approval.

RSE, ZAS contributed to conceptualization, investigation, and manuscript writing. BLW, SZ contributed to conceptualization, investigation, data curation, methodology, resources, supervision. BH, BB contributed critical revision of the manuscript. CM contributed to conceptualization, data interpretation and critical revision of the manuscript. KB contributed to conceptualization, data curation, methodology, resources, supervision, manuscript writing and review. RSE is funded by NIH 1R25NS108939,F30AG063446,F30NS111841,R01 NS110710,R25 NS108939,U01 NS117450 F30NS111841, ZAS is funded by NIH 1R25NS108939,F30AG063446,F30NS111841,R01 NS110710,R25 NS108939,U01 NS117450 F30AG063446, BL is funded by NIH 1R25NS108939,F30AG063446,F30NS111841,R01 NS110710,R25 NS108939,U01 NS117450 1R25NS108939-01, BH is funded by NIH 1R25NS108939,F30AG063446,F30NS111841,R01 NS110710,R25 NS108939,U01 NS117450 U01 NS117450, NIH 1R25NS108939,F30AG063446,F30NS111841,R01 NS110710,R25 NS108939,U01 NS117450 R01 NS110710, NIH 1R25NS108939,F30AG063446,F30NS111841,R01 NS110710,R25 NS108939,U01 NS117450 R25 NS108939. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosure statement

No potential conflict of interest relevant to this study was reported by the author(s). BH reports the following COI: Proprio Vision: investor in startup company; Progressive Neuro: investor and advisor in startup company; Galaxy Therapeutics: investor and advisor in startup company. CM has received funding from Claude D. Pepper Older Americans Independence Center and American Heart Association. KB has received compensation for consulting for Guidepoint Global and Techspert.

Data availability

Anonymized aggregate data will be shared with any qualified investigator upon request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.