THE THUNDERCLAP HEADACHE: APPROACH AND MANAGEMENT IN THE EMERGENCY DEPARTMENT

被引:18
作者
Long, Drew [1 ]
Koyfman, Alex [2 ]
Long, Brit [1 ]
机构
[1] Brooke Army Mil Med Ctr, Dept Emergency Med, 3841 Roger Brooke Dr, Ft Sam Houston, TX 78234 USA
[2] Univ Texas Southwestern Med Ctr Dallas, Dept Emergency Med, Dallas, TX 75390 USA
关键词
headache; head CT; lumbar puncture; subarachnoid hemorrhage; thunderclap; CERVICAL ARTERY DISSECTION; ANEURYSMAL SUBARACHNOID HEMORRHAGE; CEREBRAL VASOCONSTRICTION SYNDROME; LUMBAR PUNCTURE; INTRACRANIAL ANEURYSMS; RISK-FACTORS; COMPUTED-TOMOGRAPHY; VENOUS THROMBOSIS; ONSET HEADACHE; YOUNG-ADULTS;
D O I
10.1016/j.jemermed.2019.01.026
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: A thunderclap headache (TCH) is a severe headache reaching at least 7 (out of 10) in intensity within 1 min of onset, and can be the presenting symptom of several conditions with potential for significant morbidity and mortality. Objective of the Review: This narrative review evaluates the various conditions that may present with TCH and proposes a diagnostic algorithm for patients with TCH. Discussion: TCH is a symptom associated with several significant diseases. The most common diagnosed condition is subarachnoid hemorrhage (SAH). Other diagnoses include reversible cerebral vasoconstriction syndrome, cerebral venous thrombosis, cervical artery dissection, posterior reversible encephalopathy syndrome, spontaneous intracranial hypotension, and several others. Patients with TCH require history and physical examination, with a focus on the neurologic system, evaluating for these conditions, including SAH. Further testing often includes head computed tomography (CT) without contrast, CTangiography of the head and neck, and lumbar puncture. Evaluation must take into account history, examination, and the presence of any red flags or signs suggestive of a specific etiology. An algorithm is provided for guidance within this review incorporating these modalities. Management focuses on the specific diagnosis. If testing is negative for a serious condition and the patient improves, discharge home may be appropriate with follow-up. Conclusions: Patients presenting with TCH require diagnostic evaluation. History and examination are vital in assessing for risk factors for various conditions. Focused testing can assist with diagnosis, with management tailored to the specific diagnosis. Published by Elsevier Inc.
引用
收藏
页码:633 / 641
页数:9
相关论文
共 84 条
[1]   Post lumbar puncture headache: diagnosis and management [J].
Ahmed, S. V. ;
Jayawarna, C. ;
Jude, E. .
POSTGRADUATE MEDICAL JOURNAL, 2006, 82 (973) :713-716
[2]   Cerebral sinus venous thrombosis [J].
Alvis-Miranda, Hernando Raphael ;
Castellar-Leones, Sandra Milena ;
Alcala-Cerra, Gabriel ;
Moscote-Salazar, Luis Rafael .
JOURNAL OF NEUROSCIENCES IN RURAL PRACTICE, 2013, 4 (04) :427-438
[3]   Vascular risk factors and morphometric data in cervical artery dissection: a case-control study [J].
Arnold, M. ;
Pannier, B. ;
Chabriat, H. ;
Nedeltchev, K. ;
Stapf, C. ;
Buffon, F. ;
Crassard, I. ;
Thomas, F. ;
Guize, L. ;
Baumgartner, R. W. ;
Bousser, M-G .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2009, 80 (02) :232-234
[4]   Cerebral venous thrombosis: an update [J].
Bousser, Marie-Germaine ;
Ferro, Jose M. .
LANCET NEUROLOGY, 2007, 6 (02) :162-170
[5]   INITIAL AND RECURRENT BLEEDING ARE THE MAJOR CAUSES OF DEATH FOLLOWING SUBARACHNOID HEMORRHAGE [J].
BRODERICK, JP ;
BROTT, TG ;
DULDNER, JE ;
TOMSICK, T ;
LEACH, A .
STROKE, 1994, 25 (07) :1342-1347
[6]   Delirium in acute subarachnoid haemorrhage [J].
Caeiro, L ;
Menger, C ;
Ferro, JM ;
Albuquerque, R ;
Figueira, ML .
CEREBROVASCULAR DISEASES, 2005, 19 (01) :31-38
[7]   Narrative review: Reversible cerebral vasoconstriction syndromes [J].
Calabrese, Leonard H. ;
Dodick, David W. ;
Schwedt, Todd J. ;
Singhal, Aneesh B. .
ANNALS OF INTERNAL MEDICINE, 2007, 146 (01) :34-W6
[8]   Causes and predictors of death in cerebral venous thrombosis [J].
Canhao, PC ;
Ferro, JM ;
Lindgren, AG ;
Bousser, MG ;
Stam, J ;
Barinagarrementeria, F .
STROKE, 2005, 36 (08) :1720-1725
[9]   Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds [J].
Carpenter, Christopher R. ;
Hussain, Adnan M. ;
Ward, Michael J. ;
Zipfel, Gregory J. ;
Fowler, Susan ;
Pines, Jesse M. ;
Sivilotti, Marco L. A. .
ACADEMIC EMERGENCY MEDICINE, 2016, 23 (09) :963-1003
[10]   Computed tomographic angiography for the evaluation of aneurysmal subarachnoid hemorrhage [J].
Carstairs, SD ;
Tanen, DA ;
Duncan, TD ;
Nordling, OB ;
Wanebo, JE ;
Paluska, TR ;
Theodore, N ;
Riffenburgh, RH .
ACADEMIC EMERGENCY MEDICINE, 2006, 13 (05) :486-492