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IHS Diagnosis ICD-10
6.3.1 Headache attributed to saccular aneurysm [Q28.3] G44.811  

Diagnostic criteria:

  1. Any new acute headache including thunderclap headache and/or painful third nerve palsy fulfilling criteria C and D
  2. Neuroimaging evidence of saccular aneurysm
  3. Evidence exists of causation by the saccular aneurysm
  4. Headache resolves within 72 hours
  5. Subarachnoid haemorrhage, intracerebral haemorrhage and other causes of headache ruled out by appropriate investigations

Comments:

Headache is reported by approximately 18% of patients with unruptured cerebral aneurysm.

It usually has no specific features. However, thunderclap headache occurs prior to confirmed aneurysmal SAH in about 50% of patients. Although thunderclap headache may occur in the absence of vascular malformations, such malformations should be looked for by appropriate non-invasive investigations (MRA or CT angiography) and, in doubtful cases, by conventional angiography. A classic variety of "warning pain" (signalling impending rupture or progressive enlargement) is an acute third nerve palsy with retro-orbital pain and a dilated pupil, indicating an aneurysm of the posterior communicating cerebral artery or end of carotid artery.

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