The hallmark of SAH is a sudden onset, severe headache. Patients
usually describe it as the “worst headache of my life”,
and the character is unlike any prior HA the patient has experienced.
The headache is explosive, reaching a maximum within
seconds. This is in contradistinction to migraine, which even if very
severe, typically builds up over 5-30 minutes. The headache is usually
generalized, constant, not relieved by anything, and non-positional. Other signs
of meningeal irritation may be present, including neck stiffness, fever,
nausea/vomiting, and fluctuating level of consciousness. Sudden, transient loss
of consciousness may accompany the headache in nearly half of patients. The absence of focal neurologic symptoms with sudden onset headache is
the classic description of SAH, however, focal deficits may occur.
There may be milder “sentinel headaches” which occur in the weeks prior to
SAH due to small leaks of an aneurysm; these are also sudden onset headache and may
occur in any location. |
The headache of SAH is often described as severe and sudden, similar to a loud
"thunderclap". Although SAH is
characteristically associated with a thunderclap headache, rarely, other
disorders may present in the same way,
some which are benign and others that
signify serious intracranial pathology. |