Which of the following is a characteristic feature of a headache associated with subarachnoid hemorrhage?
Group of answer choices
- Associated with fever and jaw claudication
- Gradual onset over several days
- Severe, often described as the worst headache of one’s life
- Intermittent and unilateral, typically in the temporal area
The correct answer is:
Severe, often described as the worst headache of one’s life
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Explanation:
A subarachnoid hemorrhage (SAH) (often due to a ruptured aneurysm) classically presents with:
- Sudden, explosive (“thunderclap”) headache—patients often describe it as “the worst headache of my life.”
- Peak intensity within seconds to minutes (not gradual onset).
- Associated symptoms: Neck stiffness (meningismus), nausea/vomiting, photophobia, or loss of consciousness.
Why not the others?
- Fever and jaw claudication: Seen in temporal arteritis (giant cell arteritis), not SAH.
- Gradual onset over days: Suggests tension-type headache or migraine, not SAH.
- Intermittent and unilateral temporal pain: Classic for migraine or cluster headache, not SAH.
Thus, the sudden, severe, “worst ever” headache is the hallmark of SAH.
