{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:42:39Z","timestamp":1787164959903,"version":"build-2736575974"},"reference-count":8,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,11,4]],"date-time":"2017-11-04T00:00:00Z","timestamp":1509753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Subarachnoid hemorrhage (SAH) is a life\u2010threatening emergency that is frequently missed due to its varied and often subtle presentation. The most common presentation of SAH is with a severe headache. The classical adjective used in SAH is \u201cthunderclap\u201d; however, this has not been well defined in the literature, rendering it a challenge to triage patients in clinical practice presenting with severe headache.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We undertook a prospective, observational study at a tertiary academic medical center examining the clinical characteristics of the presenting headache in SAH. We enrolled patients through the emergency department and from the neurosciences intensive care unit, and documented clinical features of the headache including the time to peak intensity, location, associated symptoms, and activities that caused worsening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One hundred and fifty\u2010eight subjects were enrolled, of whom 20 patients had SAH and 138 did not. Notable distinguishing features on history included occipital location (55% in the SAH group vs 22% in the non\u2010SAH group,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001), \u201cstabbing\u201d quality (35% in the SAH group vs 5% in the non\u2010SAH group,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001), presence of prior headache (50% in the SAH group vs 83% in the non\u2010SAH group,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002), and associated meningismus (80% in the SAH group and 42% in the non\u2010SAH group,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002). Sixty\u2010five percent of patients with SAH reported that their headache peaked within 1 second of onset, compared with only 10% of those without SAH (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first study that has sought to examine in detail the clinical characteristics of the presenting headache in SAH. Our study suggests that the clinical features of headache with SAH are distinct from those associated with other headache syndromes, and that this may prove useful in the acute care setting in triaging patients with a chief complaint of headache.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.13218","type":"journal-article","created":{"date-parts":[[2017,11,4]],"date-time":"2017-11-04T02:36:35Z","timestamp":1509762995000},"page":"364-370","source":"Crossref","is-referenced-by-count":26,"title":["Distinguishing Characteristics of Headache in Nontraumatic Subarachnoid Hemorrhage"],"prefix":"10.1111","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3914-8419","authenticated-orcid":false,"given":"Brian","family":"Mac Grory","sequence":"first","affiliation":[{"name":"Department of Neurology Warren Alpert Medical School at Brown University Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linh","family":"Vu","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawna","family":"Cutting","sequence":"additional","affiliation":[{"name":"Department of Neurology Warren Alpert Medical School at Brown University Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evadne","family":"Marcolini","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Yale University School of Medicine and Yale\u2010New Haven Hospital New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Gottschalk","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Greer","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston University School of Medicine Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.28.3.660"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.16.4.587"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)91970-4"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200001063420106"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2016.06.003"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.10.025"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.65.5.791"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-2982.2002.00368.x"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fhead.13218","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.13218","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T13:21:31Z","timestamp":1762089691000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.13218"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,4]]},"references-count":8,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1111\/head.13218"],"URL":"https:\/\/doi.org\/10.1111\/head.13218","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,4]]}}}