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Thunderclap headache: is it migraine?
D W Harling1, R C Peatfield, P T Van Hille
1Department of Neurology, Pinderfields General Hospital, Wakefield, Yorkshire, UK.
Cephalalgia : an International Journal of Headache
|June 1, 1989
Summary
Sudden severe headaches, even if initially appearing normal on CT scans and CSF analysis, rarely indicate subarachnoid hemorrhage. Further angiography is often unnecessary for these "thunderclap headache" cases.
Area of Science:
- Neurology
- Neurosurgery
- Diagnostic Imaging
Background:
- Sudden severe headache, or "thunderclap headache," can mimic subarachnoid hemorrhage.
- Initial diagnostic tests like CT scans and cerebrospinal fluid (CSF) analysis may be normal in some patients.
- Distinguishing between patients with and without subarachnoid hemorrhage based solely on clinical presentation is challenging.
Purpose of the Study:
- To evaluate the long-term outcomes of patients presenting with thunderclap headache but normal initial diagnostic findings.
- To determine the necessity of angiography in managing these specific headache presentations.
Main Methods:
- Prospective study of 49 patients with sudden headache suggestive of subarachnoid hemorrhage.
- Patients with normal CT scans and CSF underwent clinical follow-up for at least 18 months.
- Outcomes assessed included recurrent headaches and definitive diagnosis of subarachnoid hemorrhage.
Main Results:
- 14 patients had normal initial investigations but presented with symptoms suggestive of subarachnoid hemorrhage.
- Over 18 months, only one patient remained headache-free.
- The majority experienced other headache types (musculoskeletal, psychogenic, migraine); none developed unequivocal subarachnoid hemorrhage.
Conclusions:
- Angiography is not clinically justified for patients with thunderclap headache and normal initial CT scans and CSF.
- The long-term prognosis for patients with normal initial workup after thunderclap headache is generally benign regarding subarachnoid hemorrhage.