Identification of clinical and paraclinical findings predictive for headache occurrence during spontaneous subarachnoid hemorrhage

Publication date: Available online 23 April 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Srdjan Ljubisavljevic, Vuk Milosevic, Aleksandar Stojanov, Marina Ljubisavljevic, Olivera Dunjic, Miroslava Zivkovic
ObjectivesHeadache is recognized as the main but unwarranted symptom of subarachnoid hemorrhage (SAH). There are no enough findings identified as predictive for headache occurrence in SAH. We evaluated the clinical and paraclinical factors predictive for headache occurrence in SAH.Patients and MethodsWe retrospectively analyzed medical records of 431 consecutive non traumatic SAH patients (264 females and 167 males), ages from 19 to 91 years, presenting with headache (70.3%) and without headache (29.7%) during period of 11years.ResultsAmong all tested parameters, as negative predictors for headache occurrence were recognized: patients' ages (OR 0.97 [95%CI: 0.96–0.99], p=0.025), persistence of coagulation abnormality (OR 0.23 [95%CI: 0.08–0.67], p=0.006), atrial fibrilation (OR 0.23 [95%CI: 0.09–0.59], p=0.002), chronic renal failure (OR 0.26 [95%CI: 0.09–0.76], p=0.014) and more diseases (OR 0.11 [95%CI: 0.04–0.32], p<0.0001), as higher clinical score (OR 0.94 [95%CI: 0.90–0.99], p=0.018) including positive neurological findings (OR 0.34 [95%CI: 0.21–0.55], p<0.001) and loss of consciousness (OR 0.22 [95%CI: 0.12–0.39], p<0.001) at the SAH onset, while the complaint of neck stiffness was identified as its positive predictor (OR 1.93 [95%CI: 1.19–3.10], p=0.007).ConclusionsAlthough diagnosis based solely on clinical presentation is not reliable and speculative, our findings could provide physicians with evidence to consider SAH not only in conditions of its headache occurrence but also in those with headache absence.



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