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Safety and Tolerability of Gabapentin for Aneurysmal Subarachnoid Hemorrhage (SAH) Headache and Meningismus

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An Erratum to this article was published on 09 December 2014

Abstract

Background

Headache after aneurysmal subarachnoid hemorrhage (SAH) is very common and is often described as the “worst headache imaginable.” SAH-associated headache can persist for days to weeks and is traditionally treated with narcotics. However, narcotics can have significant adverse effects. We hypothesize that gabapentin (GBP), a non-narcotic neuropathic pain medication, would be safe and tolerable and would reduce narcotic requirements after SAH.

Methods

We retrospectively reviewed the clinical, radiographic, and laboratory data of SAH patients at the neuroscience intensive care unit at Mayo Clinic in Jacksonville, Florida, from January 2011 through February 2013. Headache intensity was quantified by a visual analog scale score. Total opioid use per day was tabulated using an intravenous morphine equivalents scale. Cerebrospinal fluid was also reviewed when available.

Results

There were 53 SAH patients who were treated with GBP along with other analgesics for headache. Among these SAH patients, 34 (64 %) were women, with a mean age of 54 years (SD 12.3). Severe headache was observed in all SAH patients. GBP dosing was rapidly escalated within days of SAH up to a median of 1,200 mg/day, with a range of 300 mg three times a day to 900 mg three times a day. Approximately 6 % of patients treated with GBP had nausea (95 % CI 1–16 %), and only one patient (1.8 %) had to discontinue GBP.

Conclusions

GBP appears to be relatively safe and tolerable in SAH patients with headache and may be a useful narcotic-sparing agent to prevent narcotics-associated complications, such as gastrointestinal immobility, ileus, and constipation.

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Acknowledgments

This publication was supported by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). Its contents are solely the responsibility of the authors have do not necessarily represent the official views of the NIH.

Conflict of interest

The authors report no conflicts of interest or financial relationships relevant to this work and no ties to the pharmaceutical industry.

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Authors and Affiliations

  1. Department of Critical Care, Mayo Clinic, Jacksonville, FL, USA

    Laxmi P. Dhakal & Lauren K. Ng

  2. Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA

    David O. Hodge

  3. Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA

    Jay Nagal

  4. Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA

    Michael Mayes

  5. Clinical Study Unit, Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

    Alexa Richie

  6. Departments of Neurology Neurosurgery and Critical Care, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    William D. Freeman

Authors
  1. Laxmi P. Dhakal
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  2. David O. Hodge
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  4. Michael Mayes
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  5. Alexa Richie
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  6. Lauren K. Ng
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  7. William D. Freeman
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Correspondence to William D. Freeman.

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Dhakal, L.P., Hodge, D.O., Nagal, J. et al. Safety and Tolerability of Gabapentin for Aneurysmal Subarachnoid Hemorrhage (SAH) Headache and Meningismus. Neurocrit Care 22, 414–421 (2015). https://doi.org/10.1007/s12028-014-0086-5

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  • DOI: https://doi.org/10.1007/s12028-014-0086-5

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