Objectives/background: Persistent headache (PH) after an aneurysmal subarachnoid hemorrhage (aSAH) and the influence of migraine history (MH) on its evolution and prognosis is poorly understood. Our study aims are to (1) determine the prevalence, characteristics, and prognostic factors of PH after aSAH; and (2) study the impact of personal MH on PH and aSAH prognosis.
Methods: This retrospective cohort study included all adults with confirmed aSAH from January 2019 to September 2021 at a tertiary hospital. Data collected included demographics, comorbidities (including personal MH before aSAH), complementary tests, and aneurysm characteristics. The following clinical, radiological, and functional assessment scales were used: Glasgow Coma Scale (GCS), World Federation of Neurosurgical Societies (WFNS) grading scale, Hunt and Hess grading system, modified Fisher scale, VASOGRADE score, APACHE II score, and the modified Rankin Scale (mRS). PH was defined following the definition of persistent headache attributed to past nontraumatic subarachnoid hemorrhage (6.2.4.2) in the International Classification of Headache Disorders, 3rd edition. PH characteristics were assessed via phone interviews. Descriptive analyses were conducted, along with group comparisons and regression models exploring associations between MH, PH, functional outcomes, and survival.
Results: A total of 130 individuals with aSAH were included with a median age of 59.0 (interquartile range, 51.0-70.0) years and 62.3% (81 of 130) were female. For PH assessment, a total of 36.9% (48 of 130) individuals were excluded due to death, and 19.5% (16 of 82) due to lack of phone availability, resulting in a final sample of 66 individuals. PH had a prevalence of 47.0% (31 of 66) at a mean-time follow up of 3.12 ± 0.83 years. PH primarily manifested with moderate intensity (median visual analogue scale, 7), bilateral localization (51.6%; 16 of 31), and oppressive quality (77.4%; 24 of 31), with a minority of individuals experiencing nausea/vomiting (29.0%; 9 of 31) or photo/phonophobia (41.9%; 13 of 31). Up to 61.3% (19 of 31), referred moderate-severe interference of PH on daily activities. A personal MH was the only risk factor for developing PH (adjusted odds ratios [aOR], 3.9; 95% confidence interval [CI], 1.24-13.2; p = 0.022), and was present in up to 48.5% individuals (32 of 66). MH was associated with decreased aSAH clinical severity risk in both Hunt and Hess (adjusted p [adj.p] = 0.038) and WFNS (adj.p = 0.038) scales, better function outcomes (mRS) at discharge and at 3 months of follow-up (adj.p = 0.002 and adj.p = 0.003), and was independently associated with aSAH survival (aOR, 3.3; 95% CI, 1.14-11.06; p = 0.037).
Conclusion: Persistent headache affected up to 47% individuals in the long term following aSAH and significantly impacted their quality of life. A history of migraine appeared to be more common among individuals with aSAH and was associated with a three-fold increase in survival (aOR, 3.3); however, it also served as a risk factor for developing PH.
Keywords: aneurysm; disability; headache; hemorrhage; persistent; stroke.
© 2025 The Author(s). Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.