Thunderclap headache

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A thunderclap headache , also referred to as severe acute headache , is a severe headache and a sudden onset. This is defined as a severe headache that takes several seconds to minutes to reach maximum intensity. Although about 75% is associated with a "primary" headache - a headache disorder, a non-specific headache, an idiopathic thunderclap headache, or an uncertain headache - the rest secondary to other causes, which may include some very dangerous acute conditions , as well as infections and various other conditions. Typically, further investigation is carried out to identify the underlying cause.

Video Thunderclap headache

Signs and symptoms

Headaches are called "thunderclap headaches" if they are severe and reach maximum severity within seconds to minutes of onset. In many cases, there are no other abnormalities, but various causes of thunderclap headaches can cause a number of neurological symptoms.

Maps Thunderclap headache

Cause

Approximately 75% is associated with a "primary" headache: headache disorder, non-specific headache, idiopathic thunderclap headache or erratic headache disorder. The rest is secondary to a number of conditions, including:

Subarachnoid hemorrhage (10-25% of all cases of thunderclap headache)
Venous cerebral venous thrombosis
Dissection of cervical artery
Emergency hypertension (high blood pressure)
Spontaneous intracranial hypotension (unexplained low cerebrospinal fluid pressure)
Stroke (headache occurs in about 25% of strokes but is usually not a thunderclap character)
Retroclival hematoma (a hematoma behind the clivus in the skull, usually due to physical trauma but sometimes spontaneous)
Pituitary apoplection (infarction or hemorrhage of the pituitary gland)
Colloid cyst from the third ventricle
Meningitis, sinusitis
Reversible cerebral vasoconstriction syndrome (formerly Call-Fleming syndrome, multiple subtypes)
Primary cough headache, headache during primary activity, and primary sexual headache

The most important of the secondary causes are subarachnoid hemorrhage, cerebral venous sinus thrombosis, and arterial dissection in the neck.

In subarachnoid hemorrhage, there may be syncope, seizures, meningism (neck pain and stiffness), visual symptoms, and vomiting. 50-70% of people with subarachnoid hemorrhage have an isolated headache without a decrease in the level of consciousness. Headaches usually last for several days.

Cerebral venous sinus thrombosis, cerebral venous thrombosis, usually causes headaches that reflect increased intracranial pressure and are therefore aggravated by anything that makes further increased pressure, such as cough. In 2-10% of cases, headache is a thunderclap character. In most cases there are other neurological disorders, such as seizures and weakness of body parts, but in 15-30% of headaches is the only disorder.

Carotid artery dissection and vertebral artery dissection (along with cervical artery dissection), in which a tear in the blood vessel wall supplying the brain, often causes pain in the affected head or neck. Pain usually precedes other problems caused by impaired blood flow through the arteries to the brain; this may include visual symptoms, weakness of body parts, and other disorders depending on the affected blood vessels.

Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients ...

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Diagnosis

The most important initial investigation is brain computed tomography, which is very sensitive to subarakhnoid hemorrhage. If this is normal, lumbar puncture is performed, since a small fraction of SAH is missed on CT and can still be detected as xanthochromia.

If both investigations are normal, specific descriptions of headaches and other abnormalities may encourage further testing, usually involving magnetic resonance imaging (MRI). Magnetic resonance angiography (MRA) may be useful in identifying problems with arteries (such as dissection), and magnetic resonance venography (MRV) identify venous thrombosis. It is usually not necessary to proceed to cerebral angiography, a more precise but invasive investigation of the cerebral blood vessels, if the MRA and MRV are normal.

Thunderclap headache caused by the world's hottest chili pepper

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Epidemiology

The incidence of thunderclap headaches has been estimated at 43 per 100,000 people each year. Approximately 75% is associated with a "primary" headache: headache disorder, non-specific headache, idiopathic thunderclap headache or erratic headache disorder. The rest is associated with secondary causes: vascular problems, infections and other conditions.

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History

The importance of severe headaches in the diagnosis of subarachnoid hemorrhage has been known since the 1920s, when London neurologist Charles Symonds described the clinical syndrome. The term "thunderclap headache" was introduced in 1986 in a report by John Day and Neil Raskin, a neurologist at the University of California, San Francisco, in the report of a 42-year-old woman who has experienced some sudden and discovered headaches. to have an aneurysm that has not been broken.

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References

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Thunderclap headache

Jumat, 15 Juni 2018