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IHS Diagnosis ICD-10
6.2.2 Headache attributed to subarachnoid haemorrhage (SAH) [I60] G44.810  

Diagnostic criteria:

  1. Severe headache of sudden onset fulfilling criteria C and D
  2. Neuroimaging (CT or MRI T2 or flair) or CSF evidence of non-traumatic subarachnoid haemorrhage with or without other clinical signs
  3. Headache develops simultaneously with haemorrhage
  4. Headache resolves within 1 month

Comments:

Subarachnoid haemorrhage is by far the most common cause of intense and incapacitating headache of abrupt onset (thunderclap headache) and remains a serious condition (50% of patients die following SAH, often before arriving at hospital, and 50% of survivors are left disabled).

Excluding trauma, 80% of cases result from ruptured saccular aneurysms.

The headache of SAH is often unilateral at onset and accompanied by nausea, vomiting, disorders of consciousness and nuchal rigidity and less frequently by fever and cardiac dysrythmia. However, it may be less severe and without associated signs. The abrupt onset is the key feature. Any patient with headache of abrupt onset or thunderclap headache should be evaluated for SAH. Diagnosis is confirmed by CT scan without contrast or MRI (flair sequences) which have a sensitivity of over 90% in the first 24 hours. If neuroimaging is negative, equivocal or technically inadequate, a lumbar puncture should be performed.

Subarachnoid haemorrhage is a neurosurgical emergency.

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