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Headache in patients with chronic subdural hematoma: analysis in 1080 patients
Shoko M Yamada1, Yusuke Tomita2, Hideki Murakami2
1Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan. merrityamada@hotmail.co.jp.
Insights
Headache in chronic subdural hematoma (CSDH) is not caused by high pressure. Midline shift, not hematoma thickness, is the key factor, likely due to meningeal stretching.
Area of Science:
- Neurosurgery
- Neurology
- Clinical Medicine
Background:
- Headache is a common symptom in chronic subdural hematoma (CSDH).
- However, headache presentation varies, with some patients experiencing no headache despite significant hematoma and midline shift.
- Understanding the mechanism of headache in CSDH is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To investigate the underlying mechanisms of headache in patients with chronic subdural hematoma (CSDH).
- To identify factors contributing to headache presence or absence in CSDH patients undergoing surgical treatment.
Main Methods:
- A retrospective clinical study analyzing data from 1080 surgically treated CSDH patients.
- Hematoma pressure was measured in 54 cases using a glass-stick manometer during burr hole surgery.
- Ophthalmological examinations were conducted on 238 patients to assess for papilledema.
Main Results:
- Headache was present in 22.6% of CSDH patients; increased intracranial pressure signs (nausea, vomiting, papilledema) were rare (3.0% and 0.4%, respectively).
- Patients with headache were significantly younger (mean age 59.8 years) than those without (75.7 years).
- Hematoma pressure did not significantly differ between headache and non-headache groups. Hematoma thickness was greater in non-headache patients, but the ratio of midline shift to thickness was higher in headache patients.
Conclusions:
- Increased intracranial pressure and high hematoma pressure are not primary causes of headache in CSDH.
- Midline shift, particularly relative to hematoma thickness, is the most significant factor associated with headache in CSDH.
- Headache in CSDH may result from the stretching or twisting of pain-sensitive meninges and associated blood vessels.
Abstract:
Headache is a major symptom in chronic subdural hematoma (CSDH) patients. However, some CSDH patients do not complain headache although the hematoma is thick with definite midline shift. This clinical study was performed to identify the mechanism of headache in CSDH patients. We compiled clinical data of 1080 surgically treated CSDH patients (711 males and 369 females), and in 54 cases, the pressure of hematoma was measured during burr hole surgery using a glass-stick manometer. Headache was recognized in 22.6% of patients, while nausea or vomit suggesting increased intracranial pressure was detected in only 3.0%. Ophthalmological examination was performed in 238 patients, and papilledema was identified in only one patient (0.4%). The mean age of patients with headache (59.8 ± 16.9 years) was significantly younger than that of those without (75.7 ± 11.2 years) (P < 0.01). In 54 cases, the mean hematoma pressure was not significantly different between patients with (17.1 ± 6.2 mmH2O) and without (18.4 ± 7.2 mmH2O) headache (P > 0.10). Hematoma thickness was significantly greater in patients without headache (P < 0.01), but the ratio of midline shift to hematoma thickness was significantly greater in patients with headache (P < 0.01). In our results, the status of increased intracranial pressure was rare in CSDH patients, and high hematoma pressure was not a cause of headache. Midline shift was the most influenced factor for headache in our study, and based on the results, the authors consider that the potential cause of headache in CSDH might be stretching or twisting of the pain-sensitive meninges and meningeal arteries or veins.
