Distributive Frequency of Thunderclap Headache Causes Based on History Taking, Physical Examination, Brain CT scan, Lumbar Puncture, MRA, MRI and Cerebral Angiography

Abbas Ghorbani, Mehdi Shishegar, Azam Tavoosi, Saeide Rezaei Jouzdani

Abstract


Background: Thunderclap headache is an acute type of headaches which causes 1% of patients with headache referring to Emergency department. The cause of this type of headache is a serious pathology in brain which results in high mortality rate. The aim of this study is to evaluate the distributive frequency of thunderclap headache causes during one year of observation.

Materials and Methods: This observational analytical study conducted on the patients with thunderclap headache referred to Department of Neurology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran from June 2009 to June 2010. Data received from 60 patients’ filled questionnaires and the causes were evaluated by Brain CT scan, lumbar puncture (LP) and other imaging such as Brain MRA, Brain MRI and cerebral angiography. Data were analyzed by SPSS 18.0 using t-student and chi-square tests.

Results: The most common complaint was severe headache without any signs in 44 cases (73.3%). There were 16 cases with severe headache associated to additional signs such as loss of consciousness in 10 (16.7%), hemiparesis in 1 (1.7%), continuous headache in 1 (1.7%), seizure in 2 (3.4%) and severe neck pain in 1 patient (1.7%). Brain CT scan was normal in 13 patients (21.7%0). 36 patients had subarachnoid hemorrhage (60%), 3 patients had intracerebral hemorrhage (5%), 6 patients had intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) in their CT scans. From 13 patients with normal Brain CT scan, 11 patients accepted LP who 8 of them had normal result and 3 patents had SAH.

Conclusion: Thunderclap headache has high mortality rate and rapid accurate diagnosis can be lifesaving. Use of Diagnostic tests appropriately based on indications can guide physicians to correct diagnosis in a cost effective manner. In this study, LP improved 27% the accuracy of diagnosis in thunderclap headaches.

 Keywords: Thunderclap headache; Cerebral vessels aneurysm; Lumbar puncture (LP); Subarachnoid hemorrhage (SAH); Intracerebral hemorrhage (ICH)


Keywords


Thunderclap headache; Cerebral vessels aneurysm; Lumbar puncture (LP); Subarachnoid hemorrhage (SAH); Intracerebral hemorrhage (ICH)