Conflict of Interest: All authors report no conflict of interest.
Headache as a Crucial Symptom in the Etiology of Convexal Subarachnoid Hemorrhage
Article first published online: 23 AUG 2013
© 2013 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 54, Issue 3, pages 545–550, March 2014
How to Cite
Rico, M., Benavente, L., Para, M., Santamarta, E., Pascual, J. and Calleja, S. (2014), Headache as a Crucial Symptom in the Etiology of Convexal Subarachnoid Hemorrhage. Headache: The Journal of Head and Face Pain, 54: 545–550. doi: 10.1111/head.12197
- Issue published online: 4 MAR 2014
- Article first published online: 23 AUG 2013
- Manuscript Accepted: 16 JUN 2013
- subarachnoid hemorrhage;
Convexal subarachnoid hemorrhage has been associated with different diseases, reversible cerebral vasoconstriction syndrome and cerebral amyloid angiopathy being the 2 main causes.
To investigate whether headache at onset is determinant in identifying the underlying etiology for convexal subarachnoid hemorrhage.
After searching in the database of our hospital, 24 patients were found with convexal subarachnoid hemorrhage in the last 10 years. The mean age of the sample was 69.5 years. We recorded data referring to demographics, symptoms and neuroimaging.
Cerebral amyloid angiopathy patients accounted for 46% of the sample, 13% were diagnosed with reversible cerebral vasoconstriction syndrome, 16% with several other etiologies, and in 25%, the cause remained unknown. Mild headache was present only in 1 (9%) of the 11 cerebral amyloid angiopathy patients, while severe headache was the dominant feature in 86% of cases of the remaining etiologies.
Headache is a key symptom allowing a presumptive etiological diagnosis of convexal subarachnoid hemorrhage. While the absence of headache suggests cerebral amyloid angiopathy as the more probable cause, severe headache obliges us to rule out other etiologies, such as reversible cerebral vasoconstriction syndrome.