Abstract Details

Title Steroids have mild transient effects on headache in patients with Subarachnoid Hemorrhage

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P15 - Poster Session 15 (12:00 PM-1:00 PM)

Poster/Presentation
Number 13-017

Objective NA

Background Headache is the most common complaint of patients presenting with subarachnoid hemorrhage (SAH). Few studies address disease specific headache management. Corticosteroids are considered by many to be an efficacious adjuvant therapy in the management of SAH-induced headache.

Design/Methods We performed a retrospective chart review of patients treated for SAH in the neurocritical care unit at a tertiary care center from January 2018 through February 2019 who received steroids. Dexamethasone (4 mg every 6 hours) is typically administered for 2-3 days in patients with headache refractory to acetaminophen and oxycodone. Nursing documented numeric (0-10) pain scores were collected every two hours. We used paired t-tests to compare maximum daily pain scores on the day before, each day of therapy up to day 4 and the first day following steroid administration. Fisher exact and Mann-Whitney tests assessed for factors associated with steroid responsiveness defined as improvement of 3 or more points in max daily pain scores from each of the first 3 days compared to the day prior to therapy initiation.

Results There were 64 patients (68% female, median age of 55, median Hunt-Hess grade 2, median modified Fisher score 3). Thirty-seven (58%) were classified as steroid responsive. Max daily pain scores decreased during steroid administration but returned to near pre-therapy levels one day after treatment was completed. Responders reported higher pre-treatment pain scores (8.0 vs 5.8) and non-responders saw increasing pain scores over the course of therapy. No demographic or clinical characteristics were associated with steroid responsiveness.

Conclusions A subset of patients with SAH induced headache have a favorable, albeit, transient response to steroids. Further study will explore alternative dosing patterns and influence on opioid requirements.

Authors/Disclosures
Arshom Foroutan PRESENTER	No disclosure on file
Matthew N. Jaffa, DO (Ayer Neuroscience Institute, Hartford Hospital)	Dr. Jaffa has nothing to disclose.
Nikhil M. Patel, MD, MBA (Carolinas Medical Center, Atrium Health)	No disclosure on file
	No disclosure on file
Gunjan Parikh, MD (University of Maryland School of Medicine)	The institution of Dr. Parikh has received research support from Department of Defense. The institution of Dr. Parikh has received research support from NINDS. The institution of Dr. Parikh has received research support from NIH.
	No disclosure on file
Melissa Motta, MD, MPH, F�鶹��ýӳ�� (University Of Maryland Hospital in Baltimore)	Dr. Motta has nothing to disclose.
Neeraj Badjatia, MD (University of Maryland School of Medicine)	The institution of Dr. Badjatia has received research support from NIH/DOD.
Nicholas A. Morris, MD, F�鶹��ýӳ�� (University of Maryland Medical Center)	The institution of Dr. Morris has received research support from National Institute of Neurological Disorders and Stroke. The institution of Dr. Morris has received research support from �鶹��ýӳ��. The institution of Dr. Morris has received research support from National Institute of Neurological Disorders and Stroke. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Webinar Speaker with Kreg Therapeutics. Dr. Morris has a non-compensated relationship as a Editorial Board Member with �鶹��ýӳ�� that is relevant to �鶹��ýӳ�� interests or activities. Dr. Morris has a non-compensated relationship as a Editorial Board Member with Neurocritical Care Society that is relevant to �鶹��ýӳ�� interests or activities.

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