Safety and Tolerability of Gabapentin for Aneurysmal Subarachnoid Hemorrhage (SAH) Headache and Meningismus

Laxmi P. Dhakal, David O. Hodge, Jay Nagal, Michael Mayes, Alexa Richie, Lauren K. Ng, William D. Freeman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Headache after aneurysmal subarachnoid hemorrhage (SAH) is very common and is often described as the “worst headache imaginable.” SAH-associated headache can persist for days to weeks and is traditionally treated with narcotics. However, narcotics can have significant adverse effects. We hypothesize that gabapentin (GBP), a non-narcotic neuropathic pain medication, would be safe and tolerable and would reduce narcotic requirements after SAH. Methods: We retrospectively reviewed the clinical, radiographic, and laboratory data of SAH patients at the neuroscience intensive care unit at Mayo Clinic in Jacksonville, Florida, from January 2011 through February 2013. Headache intensity was quantified by a visual analog scale score. Total opioid use per day was tabulated using an intravenous morphine equivalents scale. Cerebrospinal fluid was also reviewed when available. Results: There were 53 SAH patients who were treated with GBP along with other analgesics for headache. Among these SAH patients, 34 (64 %) were women, with a mean age of 54 years (SD 12.3). Severe headache was observed in all SAH patients. GBP dosing was rapidly escalated within days of SAH up to a median of 1,200 mg/day, with a range of 300 mg three times a day to 900 mg three times a day. Approximately 6 % of patients treated with GBP had nausea (95 % CI 1–16 %), and only one patient (1.8 %) had to discontinue GBP. Conclusions: GBP appears to be relatively safe and tolerable in SAH patients with headache and may be a useful narcotic-sparing agent to prevent narcotics-associated complications, such as gastrointestinal immobility, ileus, and constipation.

Original languageEnglish (US)
Pages (from-to)414-421
Number of pages8
JournalNeurocritical Care
Volume22
Issue number3
DOIs
StatePublished - Jun 1 2015

Fingerprint

Meningism
Subarachnoid Hemorrhage
Headache
Safety
Narcotics
gabapentin
Ileus
Neuralgia
Constipation
Neurosciences
Visual Analog Scale
Morphine
Nausea
Opioid Analgesics
Intensive Care Units
Analgesics
Cerebrospinal Fluid

Keywords

  • Aneurysmal subarachnoid hemorrhage
  • Gabapentin
  • Headache
  • Meningismus

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Dhakal, L. P., Hodge, D. O., Nagal, J., Mayes, M., Richie, A., Ng, L. K., & Freeman, W. D. (2015). Safety and Tolerability of Gabapentin for Aneurysmal Subarachnoid Hemorrhage (SAH) Headache and Meningismus. Neurocritical Care, 22(3), 414-421. https://doi.org/10.1007/s12028-014-0086-5

Safety and Tolerability of Gabapentin for Aneurysmal Subarachnoid Hemorrhage (SAH) Headache and Meningismus. / Dhakal, Laxmi P.; Hodge, David O.; Nagal, Jay; Mayes, Michael; Richie, Alexa; Ng, Lauren K.; Freeman, William D.

In: Neurocritical Care, Vol. 22, No. 3, 01.06.2015, p. 414-421.

Research output: Contribution to journalArticle

Dhakal, LP, Hodge, DO, Nagal, J, Mayes, M, Richie, A, Ng, LK & Freeman, WD 2015, 'Safety and Tolerability of Gabapentin for Aneurysmal Subarachnoid Hemorrhage (SAH) Headache and Meningismus', Neurocritical Care, vol. 22, no. 3, pp. 414-421. https://doi.org/10.1007/s12028-014-0086-5
Dhakal, Laxmi P. ; Hodge, David O. ; Nagal, Jay ; Mayes, Michael ; Richie, Alexa ; Ng, Lauren K. ; Freeman, William D. / Safety and Tolerability of Gabapentin for Aneurysmal Subarachnoid Hemorrhage (SAH) Headache and Meningismus. In: Neurocritical Care. 2015 ; Vol. 22, No. 3. pp. 414-421.
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abstract = "Background: Headache after aneurysmal subarachnoid hemorrhage (SAH) is very common and is often described as the “worst headache imaginable.” SAH-associated headache can persist for days to weeks and is traditionally treated with narcotics. However, narcotics can have significant adverse effects. We hypothesize that gabapentin (GBP), a non-narcotic neuropathic pain medication, would be safe and tolerable and would reduce narcotic requirements after SAH. Methods: We retrospectively reviewed the clinical, radiographic, and laboratory data of SAH patients at the neuroscience intensive care unit at Mayo Clinic in Jacksonville, Florida, from January 2011 through February 2013. Headache intensity was quantified by a visual analog scale score. Total opioid use per day was tabulated using an intravenous morphine equivalents scale. Cerebrospinal fluid was also reviewed when available. Results: There were 53 SAH patients who were treated with GBP along with other analgesics for headache. Among these SAH patients, 34 (64 {\%}) were women, with a mean age of 54 years (SD 12.3). Severe headache was observed in all SAH patients. GBP dosing was rapidly escalated within days of SAH up to a median of 1,200 mg/day, with a range of 300 mg three times a day to 900 mg three times a day. Approximately 6 {\%} of patients treated with GBP had nausea (95 {\%} CI 1–16 {\%}), and only one patient (1.8 {\%}) had to discontinue GBP. Conclusions: GBP appears to be relatively safe and tolerable in SAH patients with headache and may be a useful narcotic-sparing agent to prevent narcotics-associated complications, such as gastrointestinal immobility, ileus, and constipation.",
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AB - Background: Headache after aneurysmal subarachnoid hemorrhage (SAH) is very common and is often described as the “worst headache imaginable.” SAH-associated headache can persist for days to weeks and is traditionally treated with narcotics. However, narcotics can have significant adverse effects. We hypothesize that gabapentin (GBP), a non-narcotic neuropathic pain medication, would be safe and tolerable and would reduce narcotic requirements after SAH. Methods: We retrospectively reviewed the clinical, radiographic, and laboratory data of SAH patients at the neuroscience intensive care unit at Mayo Clinic in Jacksonville, Florida, from January 2011 through February 2013. Headache intensity was quantified by a visual analog scale score. Total opioid use per day was tabulated using an intravenous morphine equivalents scale. Cerebrospinal fluid was also reviewed when available. Results: There were 53 SAH patients who were treated with GBP along with other analgesics for headache. Among these SAH patients, 34 (64 %) were women, with a mean age of 54 years (SD 12.3). Severe headache was observed in all SAH patients. GBP dosing was rapidly escalated within days of SAH up to a median of 1,200 mg/day, with a range of 300 mg three times a day to 900 mg three times a day. Approximately 6 % of patients treated with GBP had nausea (95 % CI 1–16 %), and only one patient (1.8 %) had to discontinue GBP. Conclusions: GBP appears to be relatively safe and tolerable in SAH patients with headache and may be a useful narcotic-sparing agent to prevent narcotics-associated complications, such as gastrointestinal immobility, ileus, and constipation.

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