“We learn in neurology that when a patient develops a sudden neurologic deficit, it’s probably stroke,” Dr. Dodick said. “When a patient presents with a sudden onset headache, with or without neurologic symptoms or signs, it’s probably vascular, and the patient needs imaging of [his or her] cerebrovascular tree.”
Dr. Dodick noted that thunderclap headache is also a condition that needs a more precise standard of care. “In most emergency departments, when patients come in with thunderclap headache, even if it’s recognized to be thunderclap, they get a CT scan and a lumbar puncture, they’re given a drug, and then they’re sent out,” he observed. “They almost never get a magnetic resonance test, and if they do, they almost never get imaging of their cerebrovascular tree.
“I really believe there needs to be a standard of care change in patients with thunderclap headache, because you don’t want to miss reversible vasoconstriction, you don’t want to miss unruptured aneurysm, and you don’t want to miss cerebral venous sinus thrombosis or arterial dissection, all potential causes of thunderclap headache in a patient with a normal neurological examination at the time of presentation.”
—John Merriman