Gómez-Dabó Laura, Gallardo Víctor J, Campos-Fernández Daniel, Rodrigo-Gisbert Marc, Iza-Achutegui Maider, Sánchez Anna, Arikan Fuat, Santamarina Estevo, Caronna Edoardo, Pozo-Rosich Patricia
Headache Clinic, Neurology Department, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Headache and Neurological Pain Research Group, VHIR, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Headache. 2025 Sep 15. doi: 10.1111/head.15052.
OBJECTIVES/BACKGROUND: Persistent headache (PH) after an aneurysmal subarachnoid hemorrhage (aSAH) and the influence of migraine history (MH) on its evolution and prognosis is poorly understood. Our study aims are to (1) determine the prevalence, characteristics, and prognostic factors of PH after aSAH; and (2) study the impact of personal MH on PH and aSAH prognosis.
This retrospective cohort study included all adults with confirmed aSAH from January 2019 to September 2021 at a tertiary hospital. Data collected included demographics, comorbidities (including personal MH before aSAH), complementary tests, and aneurysm characteristics. The following clinical, radiological, and functional assessment scales were used: Glasgow Coma Scale (GCS), World Federation of Neurosurgical Societies (WFNS) grading scale, Hunt and Hess grading system, modified Fisher scale, VASOGRADE score, APACHE II score, and the modified Rankin Scale (mRS). PH was defined following the definition of persistent headache attributed to past nontraumatic subarachnoid hemorrhage (6.2.4.2) in the International Classification of Headache Disorders, 3rd edition. PH characteristics were assessed via phone interviews. Descriptive analyses were conducted, along with group comparisons and regression models exploring associations between MH, PH, functional outcomes, and survival.
A total of 130 individuals with aSAH were included with a median age of 59.0 (interquartile range, 51.0-70.0) years and 62.3% (81 of 130) were female. For PH assessment, a total of 36.9% (48 of 130) individuals were excluded due to death, and 19.5% (16 of 82) due to lack of phone availability, resulting in a final sample of 66 individuals. PH had a prevalence of 47.0% (31 of 66) at a mean-time follow up of 3.12 ± 0.83 years. PH primarily manifested with moderate intensity (median visual analogue scale, 7), bilateral localization (51.6%; 16 of 31), and oppressive quality (77.4%; 24 of 31), with a minority of individuals experiencing nausea/vomiting (29.0%; 9 of 31) or photo/phonophobia (41.9%; 13 of 31). Up to 61.3% (19 of 31), referred moderate-severe interference of PH on daily activities. A personal MH was the only risk factor for developing PH (adjusted odds ratios [aOR], 3.9; 95% confidence interval [CI], 1.24-13.2; p = 0.022), and was present in up to 48.5% individuals (32 of 66). MH was associated with decreased aSAH clinical severity risk in both Hunt and Hess (adjusted p [adj.p] = 0.038) and WFNS (adj.p = 0.038) scales, better function outcomes (mRS) at discharge and at 3 months of follow-up (adj.p = 0.002 and adj.p = 0.003), and was independently associated with aSAH survival (aOR, 3.3; 95% CI, 1.14-11.06; p = 0.037).
Persistent headache affected up to 47% individuals in the long term following aSAH and significantly impacted their quality of life. A history of migraine appeared to be more common among individuals with aSAH and was associated with a three-fold increase in survival (aOR, 3.3); however, it also served as a risk factor for developing PH.
目的/背景：动脉瘤性蛛网膜下腔出血（aSAH）后持续性头痛（PH）以及偏头痛病史（MH）对其演变和预后的影响目前了解甚少。我们的研究目的是：（1）确定aSAH后PH的患病率、特征和预后因素；（2）研究个人MH对PH和aSAH预后的影响。
这项回顾性队列研究纳入了2019年1月至2021年9月在一家三级医院确诊为aSAH的所有成年人。收集的数据包括人口统计学、合并症（包括aSAH前的个人MH）、辅助检查和动脉瘤特征。使用了以下临床、放射学和功能评估量表：格拉斯哥昏迷量表（GCS）、世界神经外科协会联盟（WFNS）分级量表、Hunt和Hess分级系统、改良Fisher量表、VASOGRADE评分、急性生理与慢性健康状况评分系统II（APACHE II）评分以及改良Rankin量表（mRS）。PH按照《国际头痛疾病分类》第3版中归因于既往非创伤性蛛网膜下腔出血（6.2.4.2）的持续性头痛定义来定义。通过电话访谈评估PH特征。进行了描述性分析，以及组间比较和回归模型，以探索MH、PH、功能结局和生存之间的关联。
共纳入130例aSAH患者，中位年龄为59.0（四分位间距，51.0 - 70.0）岁，62.3%（130例中的81例）为女性。对于PH评估，共有36.9%（130例中的48例）因死亡被排除，19.5%（82例中的16例）因无法联系到而被排除，最终样本为66例个体。在平均3.12±0.83年的随访中，PH的患病率为47.0%（66例中的31例）。PH主要表现为中度强度（中位视觉模拟量表评分为7）、双侧定位（51.6%；31例中的16例）和压迫性性质（77.4%；31例中的24例），少数个体伴有恶心/呕吐（29.0%；31例中的9例）或畏光/畏声（41.9%；31例中的13例）。高达61.3%（31例中的19例）表示PH对日常活动有中度至重度干扰。个人MH是发生PH的唯一危险因素（调整后的优势比[aOR]，3.9；95%置信区间[CI]，1.24 - 13.2；p = 0.022），且在高达48.5%的个体（66例中的32例）中存在。在Hunt和Hess量表（调整后p[adj.p]=0.038）以及WFNS量表（adj.p = 0.038）中，MH与aSAH临床严重程度风险降低相关，在出院时和随访3个月时功能结局更好（mRS）（adj.p = 0.002和adj.p = 0.003），并且与aSAH生存独立相关（aOR，3.3；95% CI，1.14 - 11.06；p = 0.037）。
aSAH后长期来看，持续性头痛影响了高达47%的个体，并显著影响其生活质量。偏头痛病史在aSAH患者中似乎更为常见，并且与生存增加三倍相关（aOR，3.3）；然而，它也是发生PH的危险因素。
