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Related Experiment Videos

[The so-called stroke headache].

T Domzał1, B Zaleska, J Walecki

  • 1Kliniki Neurologicznej, Warszawie.

Wiadomosci Lekarskie (Warsaw, Poland : 1960)
|April 1, 1992
PubMed
Summary

Sudden severe headaches, sometimes called thunderclap headaches, may indicate minor intracranial hemorrhage. Follow-up revealed chronic headaches and brain changes in some patients, suggesting a need for specific diagnostic and management approaches.

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Area of Science:

  • Neurology
  • Neuroscience
  • Emergency Medicine

Background:

  • Sudden violent headaches, especially first-time occurrences, are often initially investigated for subarachnoid hemorrhage.
  • Diagnostic challenges arise when initial cerebrospinal fluid analysis is negative for blood.

Purpose of the Study:

  • To investigate the long-term outcomes and characteristics of patients presenting with first-time severe headaches initially suspected of subarachnoid hemorrhage but lacking definitive evidence.
  • To propose a new classification and management strategy for these specific headache presentations.

Main Methods:

  • Retrospective analysis of 20 patients with negative initial cerebrospinal fluid for subarachnoid hemorrhage.
  • Long-term follow-up including neurological examination and CT scans after 2-10 years.
  • Analysis of headache recurrence, development of chronic headaches, and identification of brain tissue changes.

Main Results:

  • Elevated protein levels in cerebrospinal fluid were noted in 8 cases.
  • Recurrent similar headaches occurred in half the patients, with hemorrhage consistently ruled out.
  • Chronic, lower-intensity headaches developed in all patients.
  • Brain scarring or atrophy was observed on follow-up CT scans in 7 cases.

Conclusions:

  • These severe headaches, termed 'thunderclap headaches,' may represent a distinct entity, possibly linked to minor intracranial hemorrhage.
  • The presence of elevated CSF protein, specific headache characteristics, and CT findings suggest hemorrhage.
  • The proposed term 'stroke headache' aims to guide diagnosis and management for these challenging cases.

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