Abstract Details

Title Time Trends in Opiate use for Headaches after Aneursymal Subarachnoid Hemorrhage

Topic Headache

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-012

Objective N/A

Background

Severe headache, a hallmark of aneurysmal subarachnoid hemorrhage (aSAH), affects up to 90% of patients during hospitalization. Opiates remain the guideline recommended mainstay of acute therapy despite their significant side effects and potential for tolerance and addiction. We evaluated time trends in opiate prescriptions, hypothesizing a decline with increasing recognition of the opioid crisis.

Design/Methods A retrospective review of 344 patients with aSAH admitted to a single tertiary-care center between 2012-2013 and 2016-2019 was performed. Patients with Hunt-Hess-Grade (HH) ≤3 able to verbalize pain scores during hospitalization were included. Univariate analysis was performed using Fischer exact or Chi square for categorical variables and Wilcoxon Mann-Whitney for non-parametric continuous variables.

Results

29 patients from 2012-12 and 42 from 2016-19 were included. Average age (years) was 50±16 (2012-13) and 57±16 (2016-19) (p=0.08), with female predominance [2012-13: 62%, 2016-19: 80%] (p=0.09). HH grade distribution was similar (HH1: 14 vs 16, p=; HH2: 5 vs 10, HH3: 10 vs 16; p=0.67). Mean maximum daily headache score (2012-13: 6.1, 2016-19: 6.2; p=0.89) and average total daily pain scores (2012-13: 1.9, 2016-19: 2.0; p=0.18) were similar. Average oral morphine equivalent was lower in 2012-13 (13.3 ± 26.2) compared to 2016-19 (19.9±19.2) (p<0.005). Double the amount of oral morphine equivalents [mg] were prescribed at discharge in 2012-13 (100±66) compared to 2016-19 2 (49±28) (p=0.05). Gabapentin and pregabalin were used more frequently in 2016-19 (n=9) versus 2012-13 (n=0) (p<0.01).

Conclusions Despite recognition of significant drawbacks of opioids, opiate use for headache control during hospitalization increased over time. However, opiate prescription at discharge decreased significantly, with increasing use of analgesics targeting neuropathic pain. Although opiate use can be appropriate in acute settings, our data suggest that there is a lack of opiate-sparing strategies for pain control, and the effect of alternative medications in reducing opiate requirements needs to be further investigated.

Authors/Disclosures
Vyas Viswanathan, MD (University of Florida, Dept. of Neurology) PRESENTER	No disclosure on file
Brandon Lucke-Wold	Mr. Lucke-Wold has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Nicholas Nelson, MD (University of Florida Department of Neurology)	No disclosure on file
Marc Alain Babi, MD (Cleveland Clinic Foundation (Florida Region))	Dr. Babi has nothing to disclose.
Christopher P. Robinson, DO (University of Florida Department of Neurology)	Dr. Robinson has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for law firms.
Carolina B. Maciel, MD, MSCR, F�鶹��ýӳ��	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, F�鶹��ýӳ�� (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 �鶹��ýӳ�� interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to �鶹��ýӳ�� interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to �鶹��ýӳ�� interests or activities.

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