Distinct Clinical Characteristics of Headache Associated With Subarachnoid Hemorrhage

subarachnoid hemorrhage
subarachnoid hemorrhage
A study identified distinguishing clinical characteristics of headaches associated with nontraumatic subarachnoid hemorrhage.

Having meningismus as well as a stabbing, occiput-located headache reaching peak pain intensity in <1 second are key clinical characteristics associated with subarachnoid hemorrhage (SAH), according to findings from a prospective study published in Headache.

Patients presenting with headache to the emergency department or neurology intensive care unit (N=158) were included in this observational study. These study participants were categorized as either having a SAH (n=20) or not having a SAH (n=138). Using a standardized questionnaire, researchers assessed associations between the incidence of SAH and headache location, time to peak headache intensity, and several other headache-related symptoms.

Participants with SAH were more likely to report headache in the occipital location than those without SAH (55% vs 22%, respectively; P <.005). In addition, patients reporting a “stabbing” quality or sensation attributable to their headache were more likely to have SAH than no SAH (35% vs 5%, respectively; P <.001).

Significantly more patients in the SAH group were also more likely to have meningismus (80% vs 42%, respectively; P =.002). Notably, a significantly greater proportion of patients reporting headaches reaching peak intensity in <1 second had SAH (65% vs 10%; P <.001).

These findings suggest that certain historical features may be specifically associated with SAH, allowing clinicians to distinguish headache associated with SAH from headache resulting from other causes.

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This study is potentially limited by its observational nature as well as patient-reported headache intensity outcomes. Also, the patients’ knowledge of their SAH diagnosis before the study may have negatively affected the delivery of the questionnaire administered by the investigators.

Findings from this study suggest potential for risk-stratifying patients based on specific clinical metrics, which may ultimately decrease the need for further potentially invasive diagnostic tests.


Mac Grory B, Vu L, Cutting S, et al. Distinguishing characteristics of headache in nontraumatic subarachnoid hemorrhage [published online November 4, 2017]. Headache. doi:10.1111/head.13218