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A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

Emma Devenney, Hazel Neale, Raeburn B Forbes1

  • 1Department of Neurology and Medical Library, Craigavon Area Hospital, Southern HSC Trust, County Armagh, Northern Ireland BT63 5QQ, UK. raeburnforbes@southern.trust.hscni.net.

The Journal of Headache and Pain
|August 16, 2014
PubMed

Insights

Sudden and severe headaches have over 100 causes besides aneurysmal subarachnoid hemorrhage. This systematic review compiles a definitive list of these causes for future reference.

Area of Science:

  • Neurology
  • Public Health

Background:

  • Sudden and severe headache, or thunderclap headache, has numerous potential causes.
  • Aneurysmal subarachnoid hemorrhage is the most critical cause.
  • Previous reviews have reported a wide range of causes, necessitating a comprehensive compilation.

Purpose of the Study:

  • To create a definitive list of causes for sudden and severe headache, excluding aneurysmal subarachnoid hemorrhage.
  • To systematically review and summarize all published causes of thunderclap headache.

Main Methods:

  • Systematic review of EMBASE and MEDLINE databases up to September 2009.
  • Extraction of data from original research papers and case reports on sudden and severe headache.
  • Summarization of identified causes, including a capture-recapture analysis for completeness.

Main Results:

  • Over 21,000 titles were screened, leading to the analysis of 213 articles describing 2345 cases.
  • A total of 119 distinct causes were identified, with 46 (38%) not previously mentioned in academic reviews.
  • The search achieved 98% completeness, identifying primary headaches and vasoconstriction syndromes as common causes, and pneumocephalus as a frequently unmentioned cause.

Conclusions:

  • Over 100 causes of sudden and severe headache, excluding aneurysmal subarachnoid hemorrhage, have been identified.
  • A definitive list of causes has been compiled for future reference.
  • There is a need for updated population-based incidence data for thunderclap headache, particularly considering cerebral vasoconstriction syndromes.
Abstract

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