CHARACTERISTICS OF THE HEADACHE ASSOCIATED WITH ACUTE CARBON MONOXIDE POISONING
Hampson NB, Hampson LA. Hyperbaric Medicine Department, Virginia Mason Medical Center , Seattle, Washington .

INTRODUCTION: Headache is the most commonly reported symptom in acute carbon monoxide (CO) poisoning. It is often described as throbbing and diffuse, however, a systematic characterization of CO-associated headache has never been published. This study examines the characteristics of CO-associated headache to determine whether any typical pattern exists which might prove useful in the diagnosis of CO exposure.

MATERIALS AND METHODS: Patients referred for hyperbaric oxygen (HBO2) treatment of acute CO poisoning were asked whether headache was part of their symptom complex. When present, specific details about the nature of the headache were collected from 100 consecutive patients through use of a standardized questionnaire.

RESULTS: Information on acute CO-associated headache was collected from 34 female and 66 male patients with mean carboxyhemoglobin (COHb) 21.3+9.3%. The most common sources of CO were motor vehicles (31), forklifts (23), or furnaces (11). Poisonings were accidental in 81%. The most common location for pain was frontal (66%), although more than one location was involved in 58%. Nature of the pain at any time during its course was dull in 72% and sharp in 36%. Headache was throbbing in 41%. Pain was continuous in 74% and intermittent in 16%. Peak intensity of pain did not correlate with COHb level. Symptoms commonly associated with headache included dizziness, lightheadedness, weakness, and nausea. Headache improved prior to HBO2 treatment in 72%, resolving entirely in 21%. Of those with residual headache, pain improved with HBO2 in 97%, resolving entirely in 44%.

CONCLUSIONS: The headache accompanying acute CO poisoning is extremely variable in nature. "Classic" throbbing diffuse headaches were rarely described by patients. There are no patterns which can be considered characteristic to aid in the diagnosis of CO-induced headache. Similarly, no trait was identified which might allow elimination of CO poisoning from the differential diagnosis of headache.

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