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Headache Management in the Neuroscience Intensive Care Unit

  • Secondary Headache (M Robbins, Section Editor)
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Abstract

Purpose of Review

Headache is a common symptom in the Neuroscience Intensive Care Unit (NeuroICU). Our goal is to provide an overview of approaches to headache management for common neurocritical care conditions.

Recent Findings

Headache disorders afflict nearly half of patients admitted to the NICU. Commonly encountered disorders featuring headache include cerebrovascular disease, trauma, and intracranial infection. Approaches to pain are highly variable, and multimodal pain regimens are commonly employed. The overall body of evidence supporting therapeutic strategies to manage headache in the critical care setting is slim, and pain control remains suboptimal in many cases with persistent reliance on opioids.

Summary

Headache is a complex, frequently occurring phenomenon in the NeuroICU care setting. At present, literature on evidence-based practice for management of headache in the critical care setting remains scarce, and despite multimodal approaches, reliance on opioids is commonplace.

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Funding

Drs. Busl and Maciel are supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number U01NS124613. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL, 32611, USA

    Daniela Pomar-Forero, Bakhtawar Ahmad, Katharina M. Busl & Carolina B. Maciel

  2. Memorial Hermann, The Woodlands Medical Center, The Woodlands, TX, 77380, USA

    Brooke Barlow

  3. Department of Neurosurgery, University of Florida, Gainesville, FL, 32611, USA

    Katharina M. Busl & Carolina B. Maciel

  4. Department of Neurology, Yale University School of Medicine, New Haven, CT, 06520, USA

    Carolina B. Maciel

  5. Department of Neurology, University of Utah, Salt Lake City, Utah, 84132, USA

    Carolina B. Maciel

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  2. Bakhtawar Ahmad
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  3. Brooke Barlow
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  4. Katharina M. Busl
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  5. Carolina B. Maciel
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Dr. Pomar-Forero drafted the manuscript and Drs. Maciel, Busl, Ahmad, and Barlow provided critical revision of the manuscript.

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Correspondence to Carolina B. Maciel.

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Daniela Pomar-Forero reports no relevant disclosures. Bakhtawar Ahmad reports no relevant disclosures. Brooke Barlow reports no relevant disclosures. Katharina M. Busl and Carolina B. Maciel are co-principal investigators on BLOCK-SAH study, which is a multicenter, randomized trial investigating the role of pterygopalatine fossa nerve block as a potential treatment in post-SAH headaches.

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Pomar-Forero, D., Ahmad, B., Barlow, B. et al. Headache Management in the Neuroscience Intensive Care Unit. Curr Pain Headache Rep (2023). https://doi.org/10.1007/s11916-023-01181-8

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