Detailed guides to painful problems, treatments & more

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

PainSci » bibliography » Devenney et al 2014
Tags: etiology, neck, medicine, pro, head/neck, spine

Three articles on PainSci cite Devenney 2014: 1. The Complete Guide to Chronic Tension Headaches2. The Complete Guide to Neck Pain & Cricks3. When to Worry About Neck Pain … and when not to!

PainSci commentary on Devenney 2014: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

The authors of this review set out to make the most complete list of causes of sudden and severe headache, AKA “thunderclap” headache. The read over 1200 scientific articles to do it, which they estimate was about 98% of all the reading on this topic that exists. So they were thorough.

They flagged a stunning one hundred and nineteen reported causes other than the main usual suspect, the most important and common: aneurysmal subarachnoid haemorrhage. Of all those other causes, “46 (38%) were not mentioned in published academic review articles.”

Cerebral vasoconstriction syndromes in particular appear to be under-represented in reviews, despite their frequent appearance in case studies, and thus “the modern epidemiology of thunderclap headache may require updating.” Understatement!

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: