SubArachnoid Hemorrhage HEadache Treated by Lumbar Puncture
SubArachnoid Hemorrhage HEadache Treated by Lumbar Puncture
Headache control is one of the major challenges in patients who suffered an acute aneurysmal
 subarachnoid hemorrhage (aSAH). Headache affects 90% of the patient and is resistant to the
 major pain medication. It results from the increased intracranial pressure and the
 inflammation caused by the accumulation of arterial blood in the subarachnoid space.
 Hemorrhagic cerebrospinal fluid (CSF) removal by a lumbar puncture (LP), is well tolerated,
 reduces intracranial pressure and accelerates the clearance of the blood products from CSF.
 Nonetheless it has never been tested in a randomized trial. The investigators aim to compare
 in patients who experienced a low grade aSAH, the variation of headache intensity after CSF
 removal by LP vs. Sham LP in addition to predefined analgesic protocol management.
After aneurysmal subarachnoid hemorrhage (aSAH) almost 90 % of patients experience a severe
 headache during their hospital stay. Pain control often requires high doses of opioid drugs
 and sedation that remain only partially efficacious. In addition, there is to the
 investigator's knowledge currently no recommendation or consensus on aSAH related headache
 management. aSAH related headache results from the prolonged increased intracranial pressure
 and meningeal inflammation related to the accumulation of blood products in the subarachnoid
 space. Preliminary studies, suggest that hemorrhagic cerebrospinal fluid (CSF) removal by
 lumbar puncture (LP) or lumbar drain, is safe and decreases intracranial pressure. However
 its impact on headache control has never been tested. A reliable headache evaluation has to
 be performed among conscious patients experiencing a "low-grade" aSAH.

 The objective of the study is to evaluate in patients experiencing low-grade acute aSAH (WFNS
 1-3), the efficacy of CSF removal by LP vs. sham LP, on headache control. 74 patients with
 secured aneurysm by coiling, will be randomized (1:1) between day 3 and day 5 after
 aneurysmal rupture. The procedure will be performed in addition to a pre-specified antalgic
 protocol.

 Mean headache intensity will be measured with the numeric verbal scale during the 24 hours
 before and the 24 hours after the procedure. The variation of mean intensity will be compared
 between the 2 groups.

 The investigators hypothesize that this treatment may significantly decrease headache
 intensity after an aSAH. If this hypothesis is confirmed CSF removal by LP could be a simple
 cost effective and worldwide available strategy to improve
Inclusion Criteria:

 -  Age >18 years

 -  Low grade subarachnoid hemorrhage (WFNS score between 1 and 3)

 -  Aneurysmal rupture ≤ 5 days

 -  Ruptured aneurysm secured by coiling since at least 48 h

 -  Headache with a mean numeric verbal scale ≥ 4/10 during the last 24 hours

 -  No contraindication for lumbar puncture

 -  Affiliation to french social security

 -  Person able to express her consent and to assess own headache intensity

 Exclusion Criteria:

 -  Minor,

 -  Pregnancy, breastfeeding

 -  Subarachnoid hemorrhage without aneurysm

 -  Ruptured aneurysm not secured

 -  High grade (WFNS 4 and 5) subarachnoid hemorrhage

 -  Efficient anticoagulation

 -  External ventricular drain placed before randomisation

 -  People under legal protection

 -  Participation to another research study with an ongoing disqualification period