How should the headache from subarachnoid hemorrhage be treated?
The 2013 European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Hemorrhage recommend acetaminophen, and in cases of severe pain, opiates, to treat subarachnoid hemorrhage associated headaches. Unfortunately opiates are often associated with nausea, vomiting, ileus, urinary retention, depressed respiratory drive, hallucinations, hypotension, and possible acute withdrawal. The treatment of headaches from subarachnoid hemorrhage is often complicated by concerns for altered mental status and the need for frequent neurologic exams. New studies are evaluating the use of gabapentin in reducing the acute and chronic pain associated with subarachnoid hemorrhage. Decadron may be beneficial during the two inflammatory peaks at day 13 and day 18.