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Looking at "thunderclap headache" differently? Circa 2016.

K Ravishankar1

  • 1The Headache and Migraine Clinics, Jaslok Hospital and Research Centre, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.

Annals of Indian Academy of Neurology
|August 30, 2016
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Summary
This summary is machine-generated.

The one-minute time frame for defining thunderclap headache (TCH) is arbitrary and difficult to assess. This study suggests revising diagnostic protocols for sudden severe headaches, prioritizing advanced imaging over immediate lumbar puncture.

Keywords:
Cerebrospinal fluid examinationinvestigation protocollumbar puncturemagnetic resonance imagingsubarachnoid hemorrhagesudden onset severe headachethunderclap headache

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • The definition of thunderclap headache (TCH) includes an arbitrary one-minute time frame from onset to peak intensity.
  • Current practice often labels headaches not strictly meeting TCH criteria as TCH, leading to standardized investigations.
  • Advances in medical knowledge reveal more conditions presenting as TCH beyond subarachnoid hemorrhage.

Purpose of the Study:

  • To question the validity and practical utility of the one-minute time frame for defining TCH.
  • To propose modifications to the investigation protocol for emergency headache scenarios.
  • To advocate for a shift in diagnostic methodology for sudden severe headaches.

Main Methods:

  • Critical review of the established one-minute time frame for TCH diagnosis.
  • Analysis of evolving evidence regarding causes of TCH and sudden severe headaches.
  • Evaluation of the impact of advanced imaging technologies on diagnostic yield.

Main Results:

  • The one-minute criterion for TCH is subjective and difficult to ascertain accurately in clinical practice.
  • Numerous conditions, not solely subarachnoid hemorrhage, can manifest as TCH or sudden severe headaches.
  • Modern imaging techniques offer improved diagnostic capabilities for these headache presentations.

Conclusions:

  • The arbitrary one-minute time frame for TCH should be reconsidered.
  • Diagnostic protocols should adapt to include more conditions presenting as TCH.
  • A shift from 'lumbar puncture first' to 'lumbar puncture last' approach, leveraging advanced imaging, is recommended.