Intended for healthcare professionals

Rapid response to:

Clinical Review

Subarachnoid haemorrhage

BMJ 2006; 333 doi: (Published 27 July 2006) Cite this as: BMJ 2006;333:235

Rapid Response:

there may be no complaint of headache when the patient first presents

Although headache is one of the cardinal symptoms of subarachnoid
haemorrhage(SAH)(1), as many as 26% of patients with SAH may present
without headache(2), a phenomenon analysed further by Weir(3). Even so,
the absence of headache should not hinder diagnosis, given the fact that,
in one study where a comparison of clinical features was made between
patients with initial misdiagnosis of SAH vs counterparts with correct
initial diagnosis, headache was absent in 4 out of 54(ie 7%) of patients
in the former category vs 29 out of 163(ie 18%) in the latter category(4).
Misdiagnosis is , however associated with increased mortality and


(1)Al-Shahi R., White PM., Davenport RJ., Lindsay KW
Subarachnoid haemorrhage
BMJ 2006:333:235-40

(2)Fontanarosa PB
Recognition of subarachnoid haemorrhage
Annals of Emergency medicine 1989:18:1199-1205

(3)Weir B
Headache from aneurysms
Cephalalgia 1994:14:79-87

(4)Mayer PL., Awad IA., Todor R., et al
Misdiagnosis of symptomatic cerebral aneurysm
Stroke 1996:27:1558-63

(5) Kowalski., Claassen J., Kreikter KT
Initial misdiagnosis and outcome after subarachnoid haemorrhage
JAMA 2004:291:866-9

Competing interests:
None declared

Competing interests: No competing interests

29 July 2006
oscar,m jolobe
retired geriatrician
1 The Lodge, 842 Wilmslow Road, Didsbury, Manchester, M20 2RN