Headaches that reach peak intensity in less than one second of onset are significantly more common in patients with subarachnoid hemorrhage (SAH) than in patients who present to a hospital with headaches caused by other conditions, according to a prospective, observational study published in the March issue of Headache. Other headache characteristics, including occipital location and a stabbing quality, also are more likely in patients with SAH.
Brian Mac Grory, MB, BCh, BAO
“Our study suggests a number of features of the clinical history that may aid in identifying those patients presenting with headache at high likelihood of having an SAH,” said Brian Mac Grory, MB, BCh, BAO, Assistant Professor of Neurology at Warren Alpert Medical School of Brown University in Providence, Rhode Island, and colleagues. “This points to the possibility that we may be able to more accurately triage patients in the acute setting based on readily obtainable clinical metrics, which has the potential to reduce the number of expensive and invasive diagnostic tests performed, as well as the number of missed diagnoses.”
SAH is a life-threatening emergency. Patients most commonly present with a severe headache, but the presentation of SAH varies and is often subtle, the researchers said.
To characterize the headache associated with SAH, Dr. Mac Grory and colleagues performed a prospective, observational study examining the clinical features of the presenting headache in people with and without SAH in the emergency department and in the neurosciences intensive care unit of a tertiary referral center. They sought to assess whether any easily obtainable features of the clinical history might allow clinicians to predict whether a person has an SAH in the acute setting. The investigators documented clinical features of the headache, including the time to peak intensity, location, associated symptoms, and activities that caused worsening.
The researchers enrolled 158 subjects, of whom 20 had SAH. Distinguishing features included occipital location (55% in the SAH group vs 22% in the non-SAH group), stabbing quality (35% in the SAH group vs 5% in the non-SAH group), presence of prior headache (50% in the SAH group vs 83% in the non-SAH group), associated meningismus (80% in the SAH group vs 42% in the non-SAH group), and headache that reached peak intensity within 1 second (65% in the SAH group vs 10% in the non-SAH group).
—Jake Remaly
Suggested Reading
Mac Grory B, Vu L, Cutting S, et al. Distinguishing characteristics of headache in nontraumatic subarachnoid hemorrhage. Headache. 2018;58(3):364-370.