The Prevalence and Long-Term Outcomes of Headaches after Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

BACKGROUND: Chronic headache after aneurysmal subarachnoid hemorrhage (aSAH) remains an ongoing area of investigation, with uncertainty regarding its prevalence and long-term outcomes. METHODS: A systematic review was conducted across five databases - Medline (Ovid), the Cochrane Central Register of Controlled Trials (Ovid), PsychInfo (Ovid), Embase (Ovid) and Scopus (Elsevier) - to identify all studies investigating the prevalence of chronic headaches after aSAH. A total of five studies were identified and included in our review. RESULTS: There were five observational studies (three cohort and two cross-sectional). The overall prevalence of chronic headaches after aSAH ranged from 16.1% to 41%, albeit across a follow-up time frame of 12 months to 7.5 years. Outcome measurements included quantitative pain scores and opioid usage; however, these were inconsistent across studies, and the studies did not address the long-term impacts of chronic headaches on quality of life or their psychosocial implications. CONCLUSION: The prevalence of chronic headache after aSAH is not well-characterized, and long-term outcomes are seldom studied, highlighting a critical gap in the current literature. Longitudinal cohort studies with standardized approaches to ascertain the psychosocial and physiological burden associated with post-aSAH chronic headaches are urgently needed.