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The term "thunderclap headache" (TCH) was first coined in 1986 by Day and Raskin to describe headache that was the presenting feature of an underlying unruptured cerebral aneurysm. The term is now well established to describe the abrupt onset headache seen with many other conditions and is also now included in The International Classification of He...
Contexts in source publication
Context 1
... it necessary in practice to set an arbitrary time limit of "one minute" from onset to peak intensity as an imperative criterion for headache to be labeled as "TCH?" Setting this time frame can sometimes mislead clinicians by lulling them into a false sense of security in certain situations, for example, when dealing with a serious SAH that develops slowly over 5 min and therefore does not fit the definition of "TCH?" 2. It is important to realize that we have moved on from the era of SAH being the only diagnosis to be excluded in patients presenting with "TCH." In the last three decades between 1986 when the term "TCH" was first coined and today in 2016, clinical neurology has progressed to include other vascular and nonvascular conditions that may present with "TCH" or "sudden onset, severe headache" [ Table 1]. These conditions were not so well known before the 21 st century and include entities such as spontaneous intracranial hypotension (SIH), reverse cerebral vasoconstriction syndrome (RCVS), and posterior reversible encephalopathic syndrome (PRES). ...Similar publications
Introduction
Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause.
Case report
An 81-year-old man with a history of shunt system placement presented among clinical d...
Background and Purpose—
Our aim was to describe variables associated with initial misdiagnosis of subarachnoid hemorrhage (SAH). We also analyzed the relationship of misdiagnosis with poor outcome and complications in good Hunt and Hess (HH) cases.
Methods—
In a prospective cohort of 401 patients with SAH, misdiagnosis was defined as failure to co...
ObjectifProposer un algorithme diagnostique rationnalisant l’utilisation de la ponction lombaire (PL) dans le diagnostic de l’hémorragie sous-arachnoïdienne (HSA) et ne la réservant qu’aux patients à haut risque. MéthodeNous avons effectué une revue extensive de la littérature de 2009 à 2014, dans la base de données Medline/Pubmed, avec les termes...
Citations
... ischemic stroke, retroclival hematoma, pituitary apoplexy, third ventricle colloid cyst, and intracranial infection. [3] Primary TCH is diagnosed when no underlying cause is discovered. [4] SAH is one of the most common causes of secondary TCH. ...
The abrupt onset of acute, high-intensity headache, unlike any experienced before, can be an urgent medical condition, which requires attention. A 32-year-old female patient developed thunderclap headache attacks had applied with increasing intensity and frequency since 1 week. She had visited the emergency department several times, and cranial computed tomography findings were normal. On the last presentation, neurological examination showed complete oculomotor nerve palsy on the left. Brain magnetic resonance imaging together with intracranial brain angiography revealed left posterior communicating aneurysm compressing the ipsilateral oculomotor nerve, with no evidence of subarachnoid hemorrhage. The patient was treated with endovascular balloon-assisted coil embolization of the aneurysm under digital subtraction angiography. As a result, the headache resolved soon after the intervention. Furthermore, complete ptosis recovered by the third month. Although thunderclap headache has rarely been attributed to an enlarging unruptured cerebral aneurysm, early recognition and treatment are rather important as it may indicate a high risk of rupture.
... ischemic stroke, retroclival hematoma, pituitary apoplexy, third ventricle colloid cyst, and intracranial infection. [3] Primary TCH is diagnosed when no underlying cause is discovered. [4] SAH is one of the most common causes of secondary TCH. ...
The abrupt onset of acute, high-intensity headache, unlike any experienced before, can be an urgent medical condition, which requires attention. A 32-year-old female patient developed thunderclap headache attacks had applied with increasing intensity and frequency since 1 week. She had visited the emergency department several times, and cranial computed tomography findings were normal. On the last presentation, neurological examination showed complete oculomotor nerve palsy on the left. Brain magnetic resonance imaging together with intracranial brain angiography revealed left posterior communicating aneurysm compressing the ipsilateral oculomotor nerve, with no evidence of subarachnoid hemorrhage. The patient was treated with endovascular balloon-assisted coil embolization of the aneurysm under digital subtraction angiography. As a result, the headache resolved soon after the intervention. Furthermore, complete ptosis recovered by the third month. Although thunderclap headache has rarely been attributed to an enlarging unruptured cerebral aneurysm, early recognition and treatment are rather important as it may indicate a high risk of rupture.
This chapter has the important function to describe the other primary headache disorders like thunderclap headache, exercise headache and sexual headache and other primary forms, but above all as forms that must alert the clinician because they can also be signs of secondary forms. The educational target is clinicians that, observing very violent and unusual forms of headache, can immediately orient themselves in the definition of primary or secondary forms, since errors in this diagnostic process could be life-threatening.
Worst-ever headache or thunderclap headache is a very severe headache that starts abruptly and is maximal in intensity at its onset. It is commonly associated with neurovascular disorders, particularly subarachnoid hemorrhage and reversible cerebral vasoconstriction. It is considered a medical emergency and warrants comprehensive evaluation to rule out underlying conditions that are associated with high morbidity and mortality. When all potential serious etiologies have been excluded, benign headache disorders can also cause this type of headache. This chapter reviews the clinical presentation, etiology, and diagnostic evaluation of worst-ever or thunderclap headache.
Purpose of Review
This work aimed to review the epidemiology, clinical criteria, and primary and secondary diagnoses of pediatric thunderclap headache and to compare to adult thunderclap headache.
Recent Findings
Thunderclap headache among children aged 6–18 years are rare; this headache presented in 0.08% of the patients admitted to a pediatric emergency department in a tertiary pediatric center. In that recent single-center study, thunderclap was a headache of grade 10 on the pain scale and conferred a benign course. Contrary to adults, in children, most thunderclap headaches are due to either a primary thunderclap headache or another type of primary headache. A number of case reports have attributed pediatric thunderclap to reversible vasoconstriction syndrome and bleeding due to intracranial aneurysm. However, 3-year data from a pediatric emergency department of one center did not find these reasons to be causes of secondary thunderclap headache. This may be due to the rarity of these diagnoses in children compared to adults. Four of the 19 patients with thunderclap headache reported in that single study had secondary thunderclap; the causes were infection in three and malignant hypertension in one. All the patients had a benign course.
Summary
Although urgent imaging and lumbar puncture are required in the workup of pediatric thunderclap, severe causes are very rare. More research is needed to investigate pediatric thunderclap headache.
Premise:
Headache is a common problem in medical practice. The International Classification of Headache Disorders (ICHD-3 beta)(1) divides all headaches into two broad categories. Most headaches seen in practice belong to the category of primary headaches, where there is no underlying structural cause identifiable. Less than 10% headaches in practice belong to the category of secondary headaches where there is an underlying condition, that can sometimes be ominous and life-threatening.
Problem:
Fear of missing a treatable serious secondary headache disorder is the most important reason why we need to investigate headache patients. There is no dilemma in investigating the patient when the clinical presentation is straightforward but when the headache presents differently or with 'red flags,' it can sometimes be quite challenging to order the right investigation and rapidly arrive at the right diagnosis.
Potential solutions:
This article looks at some of the elusive headache scenarios and outlines an approach that addresses the issue of 'appropriate' investigation in the headache patient. With advancing technology and increasing expertise, the author feels it is time now to do away with the practice of ordering an exhaustive battery of tests in all headache patients. With experience, clinicians can learn to choose tests judiciously and order specific tests based on a working diagnosis. As the title suggests, knowing 'WHEN to order WHAT test in WHICH headache patient?' forms the theme of this article.
