Pakistan Journal of Medical Sciences

Published by : PROFESSIONAL MEDICAL PUBLICATIONS

ISSN 1681-715X

HOME   |   SEARCH   |   CURRENT ISSUE   |   PAST ISSUES

-

ORIGINAL ARTICLE

-

Volume 24

July - September 2008

Number  4


 

Full Text
PDF of this Article

Diagnostic outcome of patients presenting with severe
thunderclap headache at Saidu Teaching hospital

Aziz Ahmad1, Purdil Khan2, Khalid Ahmad3, Anwar Syed4

ABSTRACT

Objective: To find out the frequency of patients attending Casualty department of a Teaching Hospital with sudden severe thunderclap headache, their diagnostic out-come and follow up.

Methodology: The study was conducted in Casualty and Medical, Departments of Saidu Teaching Hospital, Saidu Sharif, from January 2006 to December 2006. Out of 22,000 patients with different Medical problems attended Casualty department during study period of which 128 cases had acute severe thunderclap headache. Age range was 15 to 80 years with mean age of 46±10 years. Seventy eight patients (61%) were female and fifty (39%) were male. Protocol included proper clinical examination, basic laboratory investigations, admission to the General medical ward / Intensive care unit for observation, treatment and follow-up. CT scan of brain and or lumber puncture was performed in all the studied patients. The in-hospital follow up period was from two to fourteen days. The patients were reviewed one month later after discharge from hospital.

Results: Out of 120 patients twenty cases (15.6%) had Subarachnoid haemorrhage (SAH) seven patients (5.4%) had Cerebral infarction, five patients (3.9%) had an Intracerebral Haematoma. Five patients (3.9%) had aseptic meningitis. Two cases (1.5%) were reported as cerebral edema. One case (0.8%) had venous sinus thrombosis. As there was no specific finding on investigations and follow up of 88 cases (69%): these were labeled as idiopathic thunder-clap headache. Past history of not more than three similar episodes was present in 33 cases (25.78%). Out of these 33 cases, thirty belonged to the benign group of 88; other three cases had organic causes. Clinical diagnosis of Migraine was made in 37 cases out of these 88 cases.

Conclusion: Attack of severe thunderclap headache is not an un-common emergency. Attack due to Subarachnoid haemorrhage (SAH) or other serious underlying disease cannot be distinguished from non specific headaches on clinical grounds alone. It is recommended that all such patients be hospitalized and investigated properly with CT scan and or lumbar puncture to distinguish between benign and organic headaches.

KEYWORDS: Thunderclap headache, Sub-arachnoid haemorrhage, Benign headache.

Pak J Med Sci    July - September 2008    Vol. 24 No. 4    575-580

How to cite this article:

Ahmad A, Khan P, Ahmad K, Syed A. Diagnostic outcome of patients presenting with severe thunderclap headache at Saidu Teaching hospital. Pak J Med Sci 2008;24(4):575-80.


1. Aziz Ahmad, MBBS, DTM, MRCP, FRCPI
Associate Professor,
2. Purdil Khan, MBBS, DTM, MRCP, MRCPI
Assistant Professor,
3. Khalid Ahmad, MBBS
4. Anwar Syed, MBBS
Senior House Officers,
3,4: Department of Medicine,
Saidu Medical College and Teaching Hospital,
Saidu Sharif,
Swat - Pakistan.

Correspondence

Dr. Aziz Ahmad,
Associate Professor & Head, Dept. of Medicine,
Saidu Medical College, Saidu Sharif, Swat.
E-Mail: draziz7@hotmail.com 

* Received for Publication: February 8, 2008
* Revision Received: July 8, 2008
* Final Revision Accepted: July 12, 2008



HOME   |   SEARCH   |   CURRENT ISSUE   |   PAST ISSUES

Professional Medical Publications
Room No. 522, 5th Floor, Panorama Centre
Building No. 2, P.O. Box 8766, Saddar, Karachi - Pakistan.
Phones : 5688791, 5689285 Fax : 5689860
pjms@pjms.com.pk