RT Journal Article
SR Electronic
T1 Thunderclap headache syndrome presenting to the emergency department: an international multicentre observational cohort study
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 803
OP 809
DO 10.1136/emermed-2021-211370
VO 39
IS 11
A1 Tom Roberts
A1 Daniel E Horner
A1 Kevin Chu
A1 Martin Than
A1 Anne-Maree Kelly
A1 Sharon Klim
A1 Frances Kinnear
A1 Gerben Keijzers
A1 Mehmet Akif Karamercan
A1 Tissa Wijeratne
A1 Sinan Kamona
A1 Win Sen Kuan
A1 Colin A Graham
A1 Richard Body
A1 Said Laribi
A1 ,
YR 2022
UL http://emj.bmj.com/content/39/11/803.abstract
AB Background Most headache presentations to emergency departments (ED) have benign causes; however, approximately 10% will have serious pathology. International guidelines recommend that patients describing the onset of headache as ‘thunderclap’ undergo neuroimaging and further investigation. The association of this feature with serious headache cause is unclear. The objective of this study was to determine if patients presenting with thunderclap headache are significantly more likely to have serious underlying pathology than patients with more gradual onset and to determine compliance with guidelines for investigation.Methods This was a planned secondary analysis of an international, multicentre, observational study of adult ED patients presenting with a main complaint of headache. Data regarding demographics, investigation strategies and final ED diagnoses were collected. Thunderclap headache was defined as severe headache of immediate or almost immediate onset and peak intensity. Proportion of patients with serious pathology in thunderclap and non-thunderclap groups were compared by χ² test.Results 644 of 4536 patients presented with thunderclap headache (14.2%). CT brain imaging and lumbar puncture were performed in 62.7% and 10.6% of cases, respectively. Among patients with thunderclap headache, serious pathology was identified in 10.9% (95%CI 8.7% to 13.5%) of cases—significantly higher than the proportion found in patients with a different headache onset (6.6% (95% CI 5.9% to 7.4%), p<0.001.). The incidence of subarachnoid haemorrhage (SAH) was 3.6% (95% CI 2.4% to 5.3%) in those with thunderclap headache vs 0.3% (95% CI 0.2% to 0.5%) in those without (p<0.001). All cases of SAH were diagnosed on CT imaging. Non-serious intracranial pathology was diagnosed in 87.7% of patients with thunderclap headache.Conclusions Thunderclap headache presenting to the ED appears be associated with higher risk for serious intracranial pathology, including SAH, although most patients with this type of headache had a benign cause. Neuroimaging rates did not align with international guidelines, suggesting potential need for further work on standardisation.No data are available. N/A.