PROSPECTIVE-STUDY OF SENTINEL HEADACHE IN ANEURYSMAL SUBARACHNOID HEMORRHAGE

Retrospective surveys of patients with subarachnoid haemorrhage sugges t that minor episodes with sudden headache (warning leaks) may precede rupture of an aneurysm, and that early recognition and surgery might lead to improved outcome. We studied 148 patients with sudden and seve re headache (possible sentinel headache) seen by 252 general practitio ners in a 5-year period in the Netherlands. Subarachnoid haemorrhage w as the cause in 37 patients (25%) (proven aneurysm in 21, negative ang iogram in 6, no angiogram done in 6, sudden headache followed by death in 4). 103 patients had headache as the only symptom, 12 of whom prov ed to have subarachnoid haemorrhage (6 with a ruptured aneurysm). Prev ious bouts of sudden headache had occurred in only 2. Other serious ne urological conditions were diagnosed in 18. In the remaining 93, no un derlying cause of headache was found; follow-up over 1 year showed no subsequent subarachnoid haemorrhage or sudden death. In this cohort, a cute, severe headache in general practice indicated a serious neurolog ical disorder in 37% (95% CI 29-45%), and subarachnoid haemorrhage in 25% (18-32%). 12% (5-18%) of those with headache as the only symptom. The notion of warning leaks as a less serious variant of subarachnoid haemorrhage is not supported by this study. Early recognition of subar achnoid haemorrhage is important but will probably have only limited i mpact on the outcome in the general population.