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The Journal of Headache and Pain
Published in: The Journal of Headache and Pain 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Emma Devenney, Hazel Neale, Raeburn B Forbes

Published in: The Journal of Headache and Pain | Issue 1/2014

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Abstract

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.
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Metadata
Title
A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?
Authors
Emma Devenney
Hazel Neale
Raeburn B Forbes
Publication date
01-12-2014
Publisher
Springer Milan
Published in
The Journal of Headache and Pain / Issue 1/2014
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI
https://doi.org/10.1186/1129-2377-15-49

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