A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?
Acute, strong headache represent a frequent symptom with patients who report to the Emergency Neurology. Most of them have functional headaches from the group of primary headaches. However, a smaller number may have secondary headaches, due to structural changes of the cerebral parenchyma. Though the second group is considerably smaller, the secondary headaches, besides fast diagnostics require fast therapy, since they frequently imperil directly the patients life. The paper consider clinical and neurological predictions, indicating possible secondary headaches ("red flags") and diagnostic procedures, necessary to achieve their fast ethiological diagnosis. We consider also possibilities and limitations of certain additional methods (CT, cerebrospinal fluid examination, MR) with the aim to establish the examinations algorithm. Finally we offer procedures related to the therapy of acute primary as well as secondary strong headaches.