Multimodal Pain Control in Headaches Associated With Subarachnoid Hemorrhage.

Abstract

Objectives: Intractable headaches are a common occurrence in patients experiencing an aneurysmal subarachnoid hemorrhage (aSAH). Utilization of multimodal pain management regimens has become the standard of care for the treatment of acute and chronic pain. The primary objective of this study was to evaluate the use of a new multimodal pain regimen for headache in patients who have experienced aSAH.

Methods: This was an Institutional Review Board approved study evaluating the use of a multimodal pain regimen for treatment of headache pain in 104 patients who experienced aSAH in a neuro intensive care unit. Patients diagnosed with aSAH from January 2017 to December 2019, which was prior to the implementation of the multimodal pain regimen, were compared to aSAH patients from March 2020 through 2022, who were treated with the multimodal pain regimen. The primary endpoint was morphine milligram equivalent usage during the first 5 days of admission before and after the implementation of the multimodal pain regimen. The secondary endpoints were pain scores during the first 5 days of admission.

Results: As compared to those who did not receive the aSAH headache pathway (n = 39, premultimodal regimen), those who did receive the pathway (n = 65, multimodal regimen) received significantly more morphine milligram equivalents over the first 5 days of admission (30.0 [0, 97.5] vs 82.5 [15, 135]); P = 0.0053. There was no difference in the median average pain score.

Conclusions: The MM pain pathway did not reduce the total morphine equivalents utilized for the treatment of aSAH-associated headache.