Jolt Accentuation of Headache Not a Universal Indicator of Acute Meningitis

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The analysis revealed that oversimplifications led to the misconception of jolt accentuation of headache as a stand-alone, universal indicator of acute meningitis.
The analysis revealed that oversimplifications led to the misconception of jolt accentuation of headache as a stand-alone, universal indicator of acute meningitis.

Jolt accentuation of headache is not a universal indicator of meningitis for patients presenting with fever and headache, but it can be a useful early clinical tool to distinguish upper respiratory infections from acute aseptic meningitis for patients with fever, headache, and normal mental status, according to a study published in Headache.

Many clinicians regard jolt accentuation of headache as a stand-alone indicator of cerebrospinal fluid pleocytosis and the need for a lumbar puncture to confirm diagnosis. Researchers in the current study used Japanese medical databases and MEDLINE to review articles on jolt accentuation of headache that were published before December 2017. Eleven articles were included in this study, including 7 original articles on independent cohorts and 4 articles citing the original research. In addition, researchers reviewed all medical records of these cohorts to identify how the patients' backgrounds could have influenced the diagnostic valuation of jolt accentuation of headache.

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The analysis revealed that oversimplifications led to the misconception of jolt accentuation of headache as a stand-alone, universal indicator of acute meningitis. Seven of the 111 total cohort patients with pleocytosis did not experience headache at all.  Thirty-three cohort patients presented with a "false-positive" jolt accentuation of headache without pleocytosis. The diagnoses of these patients included 11 acute urinary tract infections and 7 autoimmune diseases, among other conditions. The specificity and sensitivity of jolt accentuation of headache was somewhat low in unselected groups (58.3% to 63.9%) but tended to be higher in selected subgroups with acute onset of fever and headache without neurological deficits or altered mental status (78.9%).  

As the individual usefulness of clinical tests is influenced by each individual patient situation and history, study investigators "proposed a stepwise approach to provide speedy, accurate and cost-effective medicine for patients with suspected acute meningitis. [altered mental status] and neurological deficits in themselves suggest an intracranial pathology, which may require [lumbar puncture], regardless of [jolt accentuation of headache ]. A constellation of history and physical signs can help a physician weigh the risks against the benefits of [lumbar puncture] more reliably. This approach and the diagnostic values of [jolt accentuation of headache] should be further investigated by prospective studies with operationally sorted candidates."

Reference

Tamune H, Kuki T, Kashiyama T, Uchihara T. Does this adult patient with jolt accentuation of headache have acute meningitis? [published online September 4, 2018] Headache. doi: 10.1111/head.13376

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