Diagnosis:
Clinical +exclude secondary causes (see list below e.g. subarachnoid hemorrhage, venous sinus thrombosis & others):
- Sudden onset, maximum intensity within 1 minute
- Lasts 1hr to 10 days
- Doesn’t recur within months
Note:
- Secondary causes to exclude: SAH, intracranial hematoma, arterial dissection, venous sinus thrombosis, reversible cerebral vasoconstriction syndrome (RCVS),
- Other primary headaches to exclude: primary headache associated with sexual activity, primary cough headache, primary exertional headache,
Investigations to consider:
CT: rule out SAH, intracranial hematoma, pituitary apoplexy, colloid cyst
Lumbar puncture if CT is negative: rule out SAH, Spontaneous intracranial hypotension SIH
Catheter angiography: Reversible cerebral vasoconstriction syndrome RCVS