From the Research
Management of headache in subdural hemorrhage requires a comprehensive approach focusing on both symptom relief and addressing the underlying hemorrhage, with careful pain control and neurosurgical consultation as key components. The initial management should include careful pain control with acetaminophen (1000 mg every 6 hours) as the first-line analgesic, avoiding NSAIDs and aspirin which may worsen bleeding, as suggested by general medical principles 1. For moderate to severe pain, cautious use of opioids like codeine or oxycodone may be necessary, with close monitoring for respiratory depression and altered mental status.
The underlying subdural hemorrhage must be addressed through neurosurgical consultation, with treatment options ranging from observation for small, asymptomatic hemorrhages to surgical evacuation for larger collections causing significant symptoms or neurological deficits, as outlined in the study by 2. Patients should maintain head elevation at 30-45 degrees to reduce intracranial pressure and receive antiemetics as needed for associated nausea. Regular neurological assessments are essential to monitor for deterioration. Seizure prophylaxis with levetiracetam (500-1000 mg twice daily) may be considered in high-risk patients, based on the medical management principles discussed in 1.
Some studies have explored the role of corticosteroids in the management of chronic subdural hematoma, with mixed results, as seen in 3 and 4. However, these studies do not directly address the management of headache in acute subdural hemorrhage. The management of patients with acute subdural hemorrhage during treatment with direct oral anticoagulants is also an important consideration, as discussed in 5, but the primary focus remains on addressing the underlying hemorrhage and managing symptoms.
Key considerations in the management of headache in subdural hemorrhage include:
- Careful pain control with acetaminophen as the first-line analgesic
- Neurosurgical consultation for evaluation and treatment of the underlying hemorrhage
- Maintenance of head elevation to reduce intracranial pressure
- Regular neurological assessments to monitor for deterioration
- Consideration of seizure prophylaxis in high-risk patients
- Adjustment of the headache management strategy based on the size of the hemorrhage, patient symptoms, and neurological status.