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Headache, cardiac arrest, and intracranial hemorrhage

Joji Inamasu1, Satoru Miyatake, Hideto Tomioka

  • 1Department of Emergency Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan. ginamasu@aol.com

The Journal of Headache and Pain
|July 15, 2009
PubMed

Insights

Sudden severe headache preceding cardiac arrest suggests intracranial hemorrhage. Early recognition of this headache symptom is crucial for identifying stroke causes in out-of-hospital cardiac arrest (OHCA) patients.

Area of Science:

  • Neurology
  • Emergency Medicine
  • Cardiology

Background:

  • Sudden headache is a key symptom of non-traumatic intracranial hemorrhage.
  • Intracranial hemorrhage is an uncommon cause of out-of-hospital cardiac arrest (OHCA).

Purpose of the Study:

  • To investigate the incidence and characteristics of intracranial hemorrhage in OHCA patients presenting with sudden headache.
  • To assess the diagnostic value of headache as a predictor of intracranial hemorrhage in OHCA.

Main Methods:

  • Retrospective review of medical records for witnessed OHCA patients over a 12-month period.
  • Identification of patients who complained of sudden headache preceding collapse.
  • Analysis of the incidence of intracranial hemorrhage and clinical characteristics.

Main Results:

  • Only 5% of OHCA patients reported a sudden headache before collapse.
  • All patients with headache preceding OHCA had intracranial hemorrhage (subarachnoid or cerebellar).
  • 10% of all witnessed OHCA patients had fatal intracranial hemorrhage.

Conclusions:

  • Sudden headache preceding OHCA strongly indicates intracranial hemorrhage, despite its rarity.
  • Approximately half of OHCA patients with intracranial hemorrhage may not report headache.
  • Public awareness of hemorrhagic stroke symptoms is vital for preventing sudden death.

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