IA Lidocaine and Methylprednisolone for Headache Associated With Subarachnoid Hemorrhage

Exclusion Criteria

• •1. Known allergy or hypersensitivity to lidocaine or amide-type anesthetics
• •2. Known allergy or hypersensitivity to Intralipid® (intravenous fat emulsion) or any of its components, including egg phospholipids or soy-based products
• •3. Known allergy or hypersensitivity to methylprednisolone, corticosteroids, any component of the Solu-Medrol® formulation
• •4. Diagnostic abnormalities at baseline, including ECG abnormalities (e.g., prolonged PR/QTc intervals, heart block, arrhythmias)
• •5. Cardiac conditions including history of heart block, Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, or use of antiarrhythmics
• •6. Steroid-induced psychiatric history; uncontrolled seizures; uncontrolled diabetes; glaucoma/ocular hypertension; current/recent high-dose systemic steroids.
• •7. Previous IA lidocaine or methylprednisolone (or similar) therapy prior to enrollment
• •8. Alternative headache etiology (e.g., migraines, tension-type headache)
• •9. Unable to report pain reliably due to severe cognitive or communication deficits
• •10. Severe hemodynamic instability precluding safe DSA participation
• •11. Contraindications to IA catheterization or DSA (e.g., severe peripheral vascular disease, contrast allergies)
• •12. Severe renal impairment (eGFR \<30 mL/min/1.73 m²)
• •13. Severe hepatic impairment (e.g., Child-Pugh Class C)
• •14. Active systemic infections
• •15. Severe comorbid conditions with life expectancy \<30 days
• •16. Participants who are pregnant or breastfeeding
• •17. Conditions or concomitant medications listed in the USPI for study drugs that would compromise safety or data quality
• •18. Current participation in another clinical trial