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Related Experiment Video

Updated: Jan 24, 2026

A Murine Model of Subarachnoid Hemorrhage
07:40

A Murine Model of Subarachnoid Hemorrhage

Published on: November 21, 2013

20.5K

Subarachnoid Hemorrhage and Headache.

Oyindamola Ikepo Ogunlaja1, Robert Cowan2

  • 1Neurology and Division of Headache Medicine, Stanford University, Stanford, CA, USA. oogun@stanford.edu.

Current Pain and Headache Reports
|May 25, 2019
PubMed
Summary

Subarachnoid hemorrhage (SAH) headaches are often misdiagnosed. Clinical history and the Ottawa SAH rule can help identify patients needing further investigation for this serious condition.

Keywords:
Clinical decision rulesHeadache characteristicsOttawa SAH ruleSubarachnoid hemorrhage

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Clinical Decision Making

Background:

  • Subarachnoid hemorrhage (SAH) is a critical condition often presenting as acute headache.
  • Misdiagnosis of SAH leads to significant patient morbidity and mortality.
  • Accurate early identification of SAH is crucial for timely intervention.

Purpose of the Study:

  • To review clinical history features indicative of SAH.
  • To evaluate clinical decision rules for diagnosing SAH in acute headache presentations.
  • To guide clinicians in determining which patients require further SAH investigation.

Main Methods:

  • Review of clinical history characteristics associated with SAH.
  • Analysis of the Ottawa SAH rule, a clinical decision tool.
  • Examination of criteria within the Ottawa SAH rule for patient selection.

Main Results:

  • Occipital location, stabbing quality, meningism, and exertional onset distinguish SAH headaches.
  • The Ottawa SAH rule includes criteria such as age ≥ 40, neck pain/stiffness, LOC, exertional onset, thunderclap headache, and limited neck flexion.
  • While useful for inexperienced clinicians, the Ottawa SAH rule has low specificity, necessitating tools with higher specificity.

Conclusions:

  • Clinical history and decision rules like the Ottawa SAH rule aid in diagnosing SAH.
  • An informed approach considering presentation, risk factors, and timing is essential.
  • Development of more specific clinical decision tools for SAH is needed.