TY - JOUR
T1 - Bath-related thunderclap headache
T2 - A study of 21 consecutive patients
AU - Wang, S. J.
AU - Fuh, J. L.
AU - Wu, Z. A.
AU - Chen, S. P.
AU - Lirng, J. F.
N1 - Funding Information:
This study was supported in part by a grant from the National Science Council, Taiwan under Contract No. NSC 93-2314-B-010-044- and NSC 95-2314-B-010-005.
PY - 2008/5
Y1 - 2008/5
N2 - We consecutively recruited 21 patients (all women, mean 54 ± 8 years) with bath-related thunderclap headache (BRTH). Thirteen of them were in menopause, two had just ceased hormonal therapy, and one was at 3 months postpartum. Bathing was the initial trigger for thunderclap headaches in nine patients (43%). Many patients (n = 15, 71%) had other non-bath-related attacks. Most patients (n = 18, 86%) reported that the headache occurred immediately when water was sprayed over their body, with warm water (52%) as the most common. During the disease course [mean 14 days (6-34)], the mean number of BRTH was 5.1 ± 3.6 attacks. Nineteen patients (90%) changed bathing habits to prevent attacks. Thirteen patients (62%) had magnetic resonance angiography vasoconstrictions, and two of them (15%) developed reversible posterior encephalopathy. None of the patients without vasoconstrictions had this complication. Nimodipine was effective in stopping further attacks in 84% (16/19) treated patients. No relapse was reported at a mean follow-up of 30 months. BRTH occurred exclusively in women and predominantly in middle age. Deficiency or fluctuation of female sex hormones may play a role. About 60% patients showed cerebral vasospasms, fulfilling the diagnosis of reversible cerebral vasoconstriction syndrome and indicating a risk of posterior encephalopathy.
AB - We consecutively recruited 21 patients (all women, mean 54 ± 8 years) with bath-related thunderclap headache (BRTH). Thirteen of them were in menopause, two had just ceased hormonal therapy, and one was at 3 months postpartum. Bathing was the initial trigger for thunderclap headaches in nine patients (43%). Many patients (n = 15, 71%) had other non-bath-related attacks. Most patients (n = 18, 86%) reported that the headache occurred immediately when water was sprayed over their body, with warm water (52%) as the most common. During the disease course [mean 14 days (6-34)], the mean number of BRTH was 5.1 ± 3.6 attacks. Nineteen patients (90%) changed bathing habits to prevent attacks. Thirteen patients (62%) had magnetic resonance angiography vasoconstrictions, and two of them (15%) developed reversible posterior encephalopathy. None of the patients without vasoconstrictions had this complication. Nimodipine was effective in stopping further attacks in 84% (16/19) treated patients. No relapse was reported at a mean follow-up of 30 months. BRTH occurred exclusively in women and predominantly in middle age. Deficiency or fluctuation of female sex hormones may play a role. About 60% patients showed cerebral vasospasms, fulfilling the diagnosis of reversible cerebral vasoconstriction syndrome and indicating a risk of posterior encephalopathy.
KW - Bathing headache
KW - Benign angiopathy of the central nervous system
KW - Reversible cerebral vasoconstriction syndrome
KW - Thunderclap headache
UR - http://www.scopus.com/inward/record.url?scp=41849135457&partnerID=8YFLogxK
U2 - 10.1111/j.1468-2982.2008.01541.x
DO - 10.1111/j.1468-2982.2008.01541.x
M3 - Article
C2 - 18318749
AN - SCOPUS:41849135457
SN - 0333-1024
VL - 28
SP - 524
EP - 530
JO - Cephalalgia
JF - Cephalalgia
IS - 5
ER -