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From National Yang-Ming University School of Medicine (S.-P.C., J.-L.F., J.-F.L., F.-C.C., S.-J.W.), Taipei, Taiwan; Neurological Institute (S.-P.C., J.-L.F., S.-J.W.) and Radiology Department (J.-F.L., F.-C.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine (S.-P.C.), National Yang-Ming University, Taipei, Taiwan; and Neurology Department (S.-P.C.), Taoyuan Veterans Hospital, Taoyuan, Taiwan.
Address correspondence and reprint requests to Dr. Shuu-Jiun Wang, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, 112; e-mail: sjwang{at}vghtpe.gov.tw
Objectives: To investigate the clinical pictures of patients with recurrent thunderclap headaches of unknown etiology and to field-test two relevant International Classification of Headache Disorders, 2nd edition (ICHD-II) criteria, i.e., primary thunderclap headache (Code 4.6) and benign (or reversible) angiopathy of the CNS (Code 6.7.3).
Methods: We prospectively recruited patients presenting with idiopathic recurrent thunderclap headaches from a hospital-based headache clinic. Detailed histories, neurologic examinations, and MRIs and magnetic resonance angiographies (MRAs) were performed in all patients to exclude secondary causes. Patients with cerebral vasoconstriction received serial MRA follow-up.
Results: Fifty-six consecutive patients (51 female/5 male, mean age 49.6 ± 9.8 [range 22 to 76] years) were enrolled. Segmental vasoconstriction (or benign CNS angiopathy) was found in 22 patients (39%). Thunderclap headache recurred in all patients with a median frequency of 0.7 times per day for a median period of 14 days (range 6 to 86 days). The median duration for each single attack was 3 hours. Most patients (84%) reported at least one trigger. Nimodipine effectively aborted further attacks in 83% of the treated patients. Headache attacks subsided within 3 months. Four patients (7%) developed ischemic complications. Patients with and without vasoconstriction based on MRA images were similar regarding demographics and headache profile. Except for the duration criterion, our patients generally mapped well into the proposed ICHD-II criteria.
Conclusions: This study suggests that the two diagnostic entities proposed by the ICHD-II may present different spectra of the same disorder. The distinct headache profile may help physicians quickly recognize this disabling headache disorder with risk of stroke and provide timely treatment.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 26 issue to find the title link for this article.
Supported by grants from the National Science Council of Taiwan (NSC 93-2314-B-010-044 and NSC 94-2314-B-010-019).
Disclosure: The authors report no conflicts of interest.
Received June 12, 2006. Accepted in final form September 13, 2006.
Related Article
Neurology 2006 67: 2102-2103.
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  A. Ducros, M. Boukobza, R. Porcher, M. Sarov, D. Valade, and M.-G. Bousser The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients Brain, December 1, 2007; 130(12): 3091 - 3101. [Abstract] [Full Text] [PDF]
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