Frequency and etiologies of acute and thunderclap headaches in Tohid Hospital, Sanandaj, Iran

Headache is one of the most common reasons causing the patients to refer to pain clinics. Most people have experienced severe headache at least once in their lifetime. This study aimed to investigate the prevalence of thunderclap headache and associated symptoms in Sanandaj. This descriptive study evaluated all patients admitted to Tohid Hospital in Sanandaj with acute or sudden headaches from October 2012 to September 2013. Data were collected from the patient's records. Using SPSS version 18, data were analyzed by descriptive statistics, T-test, Fisher's exact test, Chi-square, and Logistic regression. Based on the sites of the headache, 43 (36.1%) and 24 (20.2%), patients had frontal headache and generalized headache, respectively. 58 patients (48.7%) had a space-occupying lesion in the brain. 47 (39.5) patients had thunderclap headache. Among the patients with severe headache, 30 (25.2%) patients had subarachnoid hemorrhage, which was more common in the group with thunderclap headache. Results of logistic regression showed that risk of having brain injury in the patients suffering from headache of less than one week duration increases up to 11.657 times (P=0.027).This risk increases in the patients with headache aggravated by coughing or sneezing and headache with no previous history to 42 times (P=0.006) and 5.6 times respectively (P=0.052). Headaches aggravated by coughing, sneezing, and with no previous history were associated with higher incidence of space-occupying lesions (brain tumor, S.A.H,…). Also subarachnoid hemorrhage (SAH) and meningitis were two major causes of thunderclap headache. Other studies showed that migraine is the most common cause of thunderclap headache, but in emergency wards, intracranial hemorrhages including SAH & ICH were more common causes of this type of headaches. Therefore, more investigations are required for the patients with thunderclap headache.