Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 14;15(1):49.
doi: 10.1186/1129-2377-15-49.

A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

Emma Devenney, Hazel Neale, Raeburn B Forbes  1
Affiliations

A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

Emma Devenney et al. J Headache Pain. .

Abstract

Background: There are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. Published academic reviews report a wide range of causes. We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review.

Methods: Systematic Review of EMBASE and MEDLINE databases using pre-defined search criteria up to September 2009. We extracted data from any original research paper or case report describing a case of someone presenting with a sudden and severe headache, and summarized the published causes.

Results: Our search identified over 21,000 titles, of which 1224 articles were scrutinized in full. 213 articles described 2345 people with sudden and severe headache, and we identified 6 English language academic review articles. A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. Using capture-recapture analysis, we estimate that our search was 98% complete. There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. In cohort studies, the most common causes identified were primary headaches or headaches of uncertain cause. Vasoconstriction syndromes are commonly mentioned in case reports or case series. The most common cause not mentioned in academic reviews was pneumocephalus. 70 non-English language articles were identified but these did not contain additional causes.

Conclusions: There are over 100 different published causes of sudden and severe headache, other than aneurysmal subarachnoid haemorrhage. We have now made a definitive list of causes for future reference which we intend to maintain. There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral vasoconstriction syndromes.

PubMed Disclaimer

References

    1. Craig JJ, Patterson VH. Headaches in the accident and emergency department. Br J Hosp Med. 1997;57:202–206. - PubMed
    1. Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. [see comment] N Engl J Med. 2000;342:29–36. - PubMed
    1. Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol. 2006;5:621–631. - PubMed
    1. Matharu MS, Schwedt TJ, Dodick DW. Thunderclap headache: an approach to a neurologic emergency. Curr Neurol Neurosci Rep. 2007;7:101–109. - PubMed
    1. Schwedt TJ. Clinical spectrum of thunderclap headache. Expert Rev Neurother. 2007;7:1135–1144. - PubMed

Publication types

MeSH terms

LinkOut - more resources