Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache

Linn, F.; Rinkel, Gabriël J.E.; Algra, Ale; Gijn, J. van

doi:10.1136/jnnp.65.5.791

Cited by 230 publications

(142 citation statements)

References 12 publications

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“…The headache is instantaneous and reaches its peak rapidly (seconds to minutes). 1 Meningism, nausea and vomiting are common but not invariable. Seizures and loss of consciousness may occur at onset.…”

Section: Intracranial Haemorrhagementioning

confidence: 99%

Acute neurology

Tomlinson

Hanna

2007

Clinical Medicine

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Patients with acute neurological symptoms frequently present to the emergency department. The commonest presentations include headache and seizures. Careful clinical evaluation and prompt investigation are required to exclude sinister causes and initiate correct treatment. HeadacheMost patients presenting urgently with headache will not have sinister underlying pathology but the primary aim of acute assessment is the rapid identification of those with such pathology (Table 1). A careful history is critical, in particular determination of the rate of onset and location of the headache as well as any associated features. Intracranial haemorrhageSubarachnoid haemorrhage (SAH) (Fig 1) must be excluded in any patient with abrupt ('thunderclap') onset headache even in the absence of any neurological signs. The headache is instantaneous and reaches its peak rapidly (seconds to minutes). 1 Meningism, nausea and vomiting are common but not invariable. Seizures and loss of consciousness may occur at onset. If an urgent radiologist reported computed tomographic (CT) brain scan of the brain is normal, a lumbar puncture (LP) must be performed more than eight hours after ictus to assess cerebrospinal Meningitis and encephalitisHeadache, fever, meningism and altered consciousness raise the suspicion of meningitis or encephalitis. The risk of immunocompromise and history of recent travel should be documented. These features may prompt tailoring of initial antimicrobial treatment until microbial clarification is obtained.The clinical presentations of bacterial meningitis, viral meningitis and viral encephalitis may overlap. Early seizures and confusion are more likely to occur in encephalitis. Brain MRI will often show temporal lobe changes in viral encephalitis. In patients with viral meningitis and encephalitis, CSF shows mononuclear pleocytosis and Gram stain is negative. In patients with bacterial meningitis there are predominantly polymorphs in the CSF. Viral polymerase chain reaction may assist in diagnosing the commoner viral causes of meningitis or encephalitis (eg herpes simplex). EEG may be helpful in viral encephalitis and show temporal lobe changes (eg slowing or 2-3 Hz spike/wave). 6 Symptomatic management with analgesia, anti-emetics and adequate hydration is often adequate in uncomplicated viral meningitis. If there is clinical suspicion of encephalitis (seizure, delirium, obtundation), antiviral treatment should be commenced. Herpes simplex virus is the commonest cause and treatment is with aciclovir 10 mg/kg three times a day. Increased intracranial pressureHeadache which is worse in the morning, exacerbated by Valsalva manoeuvres and associated with nausea and vomiting may suggest increased ICP, but many acute headache patients without raised ICP may exhibit these clinical features. The finding of focal neurological signs with papilloedema strongly points to raised ICP. Imaging should be performed to exclude an underlying structural lesion or cerebral venous sinus thrombosis (CVST). LP should be considered o...

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Section: Intracranial Haemorrhagementioning

confidence: 99%

Acute neurology

Tomlinson

Hanna

2007

Clinical Medicine

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“…43 TCH represents one of the most recurring symptom of neurological disease in the ED. 44 The first etiology to be searched in case of a suddenonset headache is properly represented by the subarachnoid hemorrhage (ESA). 45 In fact many systematic reviews and observational studies have demonstrated that about 70% of ESA is characterized by a thunderclap pattern.…”

Section: Thunderclap Headachementioning

confidence: 99%

The management of the patient with headache: from evidence to clinical practice

Gnerre¹,

Para

Antoniis

et al. 2015

Ital J Med

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EpidemiologyHeadaches are the most prevalent neurological disorders and are among the most frequent symptoms seen in general practice. The headache is about 30% of neurological specialist visits and continues to be a frequent cause of ED use, accounting for 2% of all visits. 4 50% of the general population have headaches during any given year, and more than 90% of them report a lifetime history of headache. 5 The only Italian epidemiological study (PACE study) 6 showed that 52% of men a and 43% of women interviewed suffered from headache in the last year. 7 Primary headache Migraine IntroductionMigraine is a common, debilitating headache disor- ABSTRACTHeadaches are the most prevalent neurological disorders and continue to be a frequent cause of Emergency Department use, accounting for 2% of all visits. Although it is a neurological disease it must be also a clinical competence of internist for its nature and frequency. The keys to effective management of these syndromes are differential diagnosis through history, physical examination, and diagnostic studies when necessary. This monograph highlights the importance of establishing whether headache is a secondary symptom of another disease process or a primary condition. The goal of headache management is for patients and healthcare professionals to work together to minimize pain and improve quality of life.

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“…It is generally abrupt in onset and reaches maximal intensity instantly. However, this classic description is seen in only 50% of patients presenting with aneurysmal SAH [8]. Conversely, in those patients prospectively screened for acute severe headache, only 6-17% were demonstrated to have SAH [9,10].…”

Section: Clinical Presentationmentioning

confidence: 99%