Efficacy of Therapeutic CSF Drainage in Sub Arachnoid Hemorrhage Patients with Severe Headache in Tertiary Care Hospital
Submission: 07 November 2025 | Acceptance: 02 February 2026 | Publication: 01 March 2026
1Dr Syed Azaz Ali Shah, 2Dr Jahanzeb Liaqat, 3Dr Asif Hashmat, 4Dr Fawad Ahmad, 5Dr Syed Haris Ali Shah, 6Dr Syed Mujtaba Bacha
1Registrar Neurology, PEMH Rwp
2Consultant Medical Specialist & Neurologist, PEMH Rwp
3Professor of Medicine, CMH Lahore
4Consultant Medical Specialist & Neurologist, PEMH Rwp
5House Officer, Saidu Teaching Hospital, Swat
6Internee, Saidu Teaching Hospital, Swat
ABSTRACT
Aim: This study was carried out with an aim of determining the effectiveness of the therapeutic cerebrospinal fluid (CSF) drainage in the reduction of severe headache in patients who had aneurysmal subarachnoid hemorrhage (SAH).
Methodology: The study was carried out at the Department of Neurology at the Pak Emirates Military Hospital, Rawalpindi, through a cross-sectional study. 90 patients aged 18-70 years with non-traumatic aneurysmal SAH who present themselves with severe headache (Visual Analog Scale 7 or more) were selected using consecutive non-probability sampling. Therapeutic CSF drainage was performed by use of either external lumbar drainage or external ventricular drainage to patients. The visual analog scale was used to measure the severity of headache at baseline, and 24, 48 and 72 hours of drainage.
Results: The patients were of mean age of 52.4+10.8 years and 52 (57.8) males and 38 (42.2) females. Grade II (24.4) and grade III (22.2) were the most common WFNS grades. Mean baseline VAS score was 8.6/0.9, which implies severe headache upon presentation. Mean VAS score at 24 hours, 48 hours, and 72 hours showed a steady improvement in the severity of headache after CSF drainage therapy (mean 6.1 ± 1.3, 5.2 ± 1.4, and 5.0 ± 1.5). The average decrease in the VAS score at 24 hours, 48 hours and 72 hours was 2.5, 3.4 and 3.6 respectively, and statistically significant (p < 0.001). In general, the predetermined efficacy outcome (30 percent decrease in VAS score) occurred in 63 (70.0%) patients at the 48 hours point. In terms of drainage methods, 56 patients (62.2) were external lumbar drained and 34 (37.8) ones were external ventricular drained. Persistent draining was done in 64.4 percent of cases and the average volume, which was drained, was 18.7 ± 6.4 mL/day. Regarding safety outcomes, 65 patients (72.2% did not get any complications, CSF over-drainage in 7.8, neurological worsening in 6.7, drain related infection in 5.6, meningita in 4.4 and rebleeding in 3.3).
Conclusion: It was found that therapeutic cerebrospinal fluid (CSF) drainage is a safe and efficacious intervention that can be applied to the reduction of the severity of headache in patients with aneurysmal subarachnoid hemorrhage, leading to the achievement of crucial changes in the severity of pain and overall clinical outcomes.
Keywords: Subarachnoid hemorrhage, Cerebrospinal fluid drainage, Severe headache, Lumbar drainage, External ventricular drainage, Visual Analog Scale, Aneurysmal SAH.