Effective headache management in the aneurysmal subarachnoid patient: a literature review

Subarachnoid haemorrhage (SAH) is described throughout the literature as a devastating neurological disorder associated with significant mortality and morbidity rates, arising not just from the haemorrhage itself, but also as a result of the catastrophic multisystem sequelae that can accompany the condition. Rupture of an intracranial aneurysm accounts for up to 85% of instances of SAH, occurring in approximately 6–7 per 100,000 in most populations and costing an estimated £510 million annually in the United Kingdom alone (Rivero-Arias et al, 2010). Treatment of Aneurysmal Subarachnoid Haemorrhage (aSAH) includes prevention of re-bleeding, evacuation of space occupying haematomas, management of hydrocephalus and prevention of secondary cerebral insult. Headache has been highlighted as the predominant, most characteristic and often the only symptom of aSAH, its severity having a variety of physiological and psychological effects on the patient. This paper summarises the findings of a literature review conducted as part of a research study to examine existing practices in the assessment and management of headache in patients with aSAH in an Irish Neurosciences Centre. The review demonstrates that despite a wealth of published literature on the diagnosis and management of aSAH, evaluation and management of its main symptom, headache, remains suboptimal and under-researched. The lack of available literature demonstrates that such enquiry is both timely and necessary.