An-Najah Staff

Background: The molecular mechanisms of headache pain have not yet been clarified.  Headache is an easily identifiable, clinically important but commonly neglected condition  among patients with acute acetaminophen overdose.    Objectives: The objectives of this study were to investigate the prevalence of headache  in patients presenting to hospital after acetaminophen overdose, to compare clinical  characteristics among patients with and without headache, and to determine which  clinical findings would be most predictive of headache in hospitalized patients after  acetaminophen overdose. 

Methods: This is a retrospective cohort study of hospital admissions for acute  acetaminophen overdose which was conducted over a period of 4 years from January 1,  2005 to December 31, 2008. Demographic data, clinical characteristics, and predictors of  headache were analyzed among those patients. Pearson chi-square test, student’s t test,  and Mann-Whitney U test were used in univariate analysis while multiple logistic  regression was used to identify factors associated with headache. SPSS 15 was used for  data analysis.     

Results: Two hundred and fifty five patients were studied; their mean age was 23.1±1.6  years; 83.9% of them were females and 14.9% had headache during hospitalization.  Headache among patients was significantly associated with N-acetylcysteine (NAC)  administration (OR=2.9;  95%  CI=1.48-5.74; P=0.001), intentionally ingested drug  (OR=5.31;  95%  CI=0.75-37.4; P=0.04), acetaminophen concentration above ‘high-risk’  treatment line (OR=1.84; 95% CI=1.1-3.36; P=0.04), higher acetaminophen  concentration (mean=99.8 mg/L; 72.5-127.1, P= 0.04), and long hospital stay (mean=60  hours; 95%  CI=45.3-74.7; P=0.03). Multiple logistic regression showed that significant  risk factor for headache was seen among patients with NAC administration (P = 0.04).    Conclusion: We recorded—in our geographical area—a high frequency of headache in  patients with acute acetaminophen overdose. This study suggests that among those  patients, the use of NAC is associated with increased risk of headache