Early ReportThunderclap headache as first symptom of cerebral venous sinus thrombosis*
Introduction
The characteristics of thunderclap headache are abrupt onset and very severe pain. In patients with thunderclap headache subarachnoid haemorrhage is a possible diagnosis. Other causes include migraine, dissection of a carotid or vertebral artery, or benign thunderclap headache. Cerebral venous sinus thrombosis (CVST) is generally not considered in these cases.1, 2 We report ten patients with proven CVST, who presented with acute severe headache mimicking subarachnoid haemorrhage.
Section snippets
Patients and methods
We collected medical histories of 71 patients who had CVST between 1992 and 1996. 48 of these patients took part in the Dutch-European Cerebral Sinus Thrombosis randomised trial of low-molecular-weight heparin for 3 weeks compared with placebo. In all patients CVST was confirmed by conventional angiography or magnetic resonance imaging plus magnetic resonance angiography. Ten patients presented with acute severe headache. This headache developed within seconds, and was the first or worst
Case reports
Patient 5, a 37-year-old woman (table), had a right-sided headache, radiating to the neck, for several weeks. On the day before admission she felt a left-sided headache after a cough (cough headache). The next day she experienced a sudden “snap” in the head and at the same time a very severe headache. She was transferred to a neurosurgical department with a diagnosis of subarachnoid haemorrhage. On examination she was conscious and fully oriented. General and neurological examinations found no
Discussion
Thunderclap headache raises the suspicion of subarachnoid haemorrhage caused by a ruptured aneurysm or by a benign perimesencephalic haemorrhage. If such haemorrhage is excluded by a normal computed tomography scan and normal CSF examination, the most likely diagnosis is benign thunderclap headache if the patient remains neurologically normal.3 In our patients with thunderclap headache, CVST caused headache and clinical signs and symptoms that were clinically indistinguishable from subarachnoid
References (10)
- et al.
Long-term follow-up of 71 patients with thunderclap headache mimicking subarachnoid haemorrhage
Lancet
(1988) Diagnosing the severe headache
Neurology
(1994)- et al.
The diagnosis of subarachnoid haemorrhage
J Neurol Neurosurg Psychiatr
(1990) - et al.
Clinical presentation of ruptured intracranial aneurysm
J Neurol Neurosurg Psychiatr
(1967) - et al.
Pitfalls in the recognition of subarachnoid haemorrhage
JAMA
(1980)
Cited by (250)
Headache due to Vascular Disorders
2024, Neurologic ClinicsPost cerebral venous thrombosis headache – Prevalence, mechanisms and risk factors
2024, Journal of Clinical NeuroscienceApproach to a patient with headache
2022, Headache and Migraine in PracticeHeadache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes, An Update
2021, Emergency Medicine Clinics of North AmericaCerebral Venous Thrombosis
2021, Stroke: Pathophysiology, Diagnosis, and ManagementCerebral venous thrombosis: a practical review
2024, Postgraduate Medical Journal
- *
Participants listed at the end of article