After spinal cord injury, sudden severe headache and sweating: first help the person sit upright, loosen clothing, and call 120

In someone with a spinal cord injury, part of the body’s alarm wiring is cut. A full bladder or tight clothes may not be felt, yet blood pressure can shoot up. The signal is sudden severe headache and sweating. Help the person sit upright, loosen anything tight, check whether urine is being held, and call 120 at the same time.

Cost

No money. Three actions, done in a few dozen seconds.

Benefit

This episode is called autonomic dysreflexia. A systematic review searched Medline, CINAHL, EMBASE, and PsycINFO, included 31 studies, and of those 6 were randomized controlled trials. The review states that non-drug management during an episode is three steps: put the patient in an upright position, loosen tight clothing, and remove the triggering stimulus. Those three steps rest on clinical consensus and physiology data and are Level 5 evidence. The review body text states that episodes are most common with injury at thoracic level 6 or above, and the most common triggers are bladder or bowel irritation. Stimuli below the injury level set off a large sympathetic discharge, blood pressure rises sharply, and sensation below the injury is partly or wholly gone. Symptoms include severe headache and heavy sweating above the injury level; there may also be no symptoms at all. Untreated, it can lead to intracranial hemorrhage, seizures, or death. No study specifically measured the effect of sitting up during an episode, but when people with spinal cord injury go from lying flat to sitting or tilting, resting blood pressure falls clearly. Antihypertensive drugs are used only when blood pressure stays high; among them prazosin has Level 1 evidence, and nifedipine and prostaglandin E2 have Level 2 evidence. The review also states that prevention mainly targets urogenital and surgical triggers, and most of that evidence is only Level 4 or Level 5

Notes

Grade B because those three on-the-spot actions have no randomized controlled trial behind them, only consensus and physiological reasoning. The review itself says most of these methods are backed only by uncontrolled studies. The drug paragraph is for clinicians; do not give blood-pressure medicine at home. Laying the person flat raises blood pressure further, so sit them upright. Family and aides need these three steps too. Do not tough it out as an ordinary headache.

Sources · 1

1. Krassioukov A, Warburton DE, Teasell R, Eng JJ; Spinal Cord Injury Rehabilitation Evidence Research Team (2009). A systematic review of the management of autonomic dysreflexia after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 90(4):682-695. doi.org/10.1016/j.apmr.2008.10.017