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Research ArticleOriginal Article
Open Access

Thunderclap headache management among Emergency Department visitors in tertiary care center in Makkah City: Retrospective cohort study

Fadi S. Althobaiti, Saud Y. Alsharif, Muhannad A. Alhazmi, Abdullah H. BinMelieh, Abdulaziz A. Almqaiti, Ziyad K. Alsaedi, Amal M. Alkhotani and Bassam G. Sef
Neurosciences Journal April 2025, 30 (2) 131-137; DOI: https://doi.org/10.17712/nsj.2025.2.20240098
Fadi S. Althobaiti
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
Roles: Medical Student
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  • ORCID record for Fadi S. Althobaiti
  • For correspondence: [email protected]
Saud Y. Alsharif
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
Roles: Medical Student
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Muhannad A. Alhazmi
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
Roles: Medical Student
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Abdullah H. BinMelieh
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
Roles: Medical Student
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Abdulaziz A. Almqaiti
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
Roles: Medical Student
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Ziyad K. Alsaedi
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
Roles: Medical Student
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Amal M. Alkhotani
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
MBBS
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Bassam G. Sef
From the College of Medicine (Althobaiti, Alsharif, BinMelieh, Almqaiti, Alsaedi, Alhazmi), Department of Medicine (Alkhotani), Umm Al-Qura University, and from Neurology Department (Sef), King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
MBBS
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  • Article
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Article Figures & Data

Tables

    • View popup
    Table 1

    - Demographic factors and associated comorbidities. (n=173)

    Agemin=15, max=105
    Mean±SD52.6243±14.8
    Median52
    Factorsn (%)
    Gender 
    Female74 (42.8)
    Male99 (57.2)
    Nationality 
    Saudi99 (57.2)
    Non-Saudi74 (42.8)
    Comorbidity 
    Cardiac Disease16 (9.2)
    Diabetes Mellitus35 (20.2)
    Hypertension69 (39.9)
    Chronic Kidney Disease7 (4.0)
    Thyroid Disease5 (2.9)
    Previous Stroke3 (1.7)
    None66 (38.2)
    • View popup
    Table 2

    - Frequency of associated clinical features. (n=173)

    Presentationn (%)
    Clinical feature 
    Decrease in Level of Consciousness2 (1.2)
    Dizziness8 (4.6)
    Confusion8 (4.6)
    Fatigue5 (2.9)
    Loss of Consciousness48 (27.7)
    Nausea/Vomiting71 (41.0)
    Neck Pain9 (5.2)
    Weakness15 (8.7)
    Seizure18 (10.4)
    Photophobia21 (12.1)
    Visual Impairment8 (4.6)
    Memory Loss3 (1.7)
    Sensory Disturbance5 (2.9)
    Prior History of Headache25 (14.5)
    None33 (19.1)
    Examination 
    Pinpoint Pupils11 (6.4)
    Comatosed18 (10.4)
    Neck Stiffness36 (20.8)
    Fever4 (2.3)
    Hypertension12 (6.9)
    Normal73 (42.2)
    • View popup
    Table 3

    - Final diagnoses of patients with TCH and assessment of Patients Diagnosed with SAH. SAH - Subarachnoid Hemorrhage, ICH - Intracerebral Hemorrhage, SDH - Subdural Hematoma, ACA - Anterior Cerebral Artery, MCA-Middle Cerebral Artery, CT - Computed Tomography, ED -Emergency Department. n=173

    Diagnosisn(%)
    Hemorrhagic Conditions (91.3%)  
    SAH148(85.5)
    ICH4(2.3)
    SDH6(3.5)
    Aneurysms (3.5%)  
    Basilar Fusiform Aneurysm1(0.6)
    Bilateral Saccular Aneurysm of ICA1(0.6)
    Non-ruptured Left ACA Aneurysm3(1.7)
    Non-ruptured Left MCA Aneurysm1(0.6)
    Vascular Malformations (2.9%)  
    Vascular Malformation5(2.9)
    Other Conditions (2.3%)  
    COVID-191(0.6)
    Cerebral Venous Thrombosis1(0.6)
    Ischemic Stroke1(0.6)
    Ruptured Arachnoid Cyst1(0.6)
    Assessment of Patients Diagnosed with SAH (n=148)
    CriteriaNoYes
    Was the CT requested within 6 hours of the patient’s ED arrival?1 (0.7)147 (99.3)
    Were the CT results reported within 6 hours of the patient’s ED arrival?7 (4.7)141 (95.3)
    Was the CT able to detect SAH?1 (0.7)147 (99.3)
    Patient’s outcomen (%)
    Death12 (8.1)
    Recovery132 (89.2)
    Unknown4 (2.7)
    • View popup
    Table 4

    - Compliance with ICHD-3 Recommendations. ICHD-3 - International Classification of Headache Disorders, 3rd Edition; CTA - Computed Tomographic Angiography; MRI - Magnetic Resonance Imaging; LP - Lumbar Puncture. (n=173)

    Compliancen(%)Details of Non-Compliance
    No6(3.5)Second InvestigationCTA instead of LP: 5
    MRI instead of LP: 1
    Yes167(96.5) 
    • View popup
    Table 5

    - Association of demographic characteristics with final diagnoses of TCH and SAH outcomes. TCH: Thunderclap Headache.

    Association of demographic characteristics with final diagnoses of TCH (n=173)
    AgeFinal Diagnosis  
     AneurysmsHemorrhagic conditionsOther conditionsVascular malformationF valuePr(>F)
    n (%)6 (3.5)158 (91.3)4 (2.3)5 (2.9)1.87000.1365
    Mean ± SD48.7 ± 1353.4 ± 14.640.75 ± 21.143.0 ± 13.75  
    Median48.053.040.547.0  
    Min30152222  
    Max651056058  
    Gender n (%)      
    Female1 (1.35)68 (91.9)2 (2.7)3 (4.05)74 (100)0.4999
    Male5 (5.05)90 (90.9)2 (2.0)2 (2.0)99 (100) 
    Total6 (3.5)158 (91.3)4 (2.3)5 (2.9)173 (100) 
    Nationality      
    Non-Saudi3 (4.1)70 (94.6)01 (1.35)74 (100)0.2281
    Saudi3 (3.0)88 (88.9)4 (4.0)4 (4.0)99 (100) 
    Total6 (3.5)158 (91.3)4 (2.3)5 (2.9)173 (100) 
    Association of demographic characteristics with SAH patient outcomes (n=148)
    AgeOutcome  
     DeathRecoveryUnknownF valuePr(>F) 
    n (%)12 (8.1)132 (89.2)4 (2.7)1.71890.1829 
    Mean ± SD49.1±19.053.0±13.764.5±23.3   
    Median43.552.554.5   
    Min221550   
    Max7910599   
    Gender      
    Female4 (6.0)61 (91.0)2 (3.0)67 (100)0.6793 
    Male8 (9.9)71 (87.65)2 (2.5)81 (100)  
    Total12 (8.1)132 (89.2)4 (2.7)148 (100)  
    Nationality      
    Non-Saudi5 (7.6)58 (87.9)3 (4.55)66 (100)0.4581 
    Saudi7 (8.5)74 (90.2)1 (1.2)82 (100)  
    Total12 (8.1)132 (89.2)4 (2.7)148 (100)  
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Thunderclap headache management among Emergency Department visitors in tertiary care center in Makkah City: Retrospective cohort study
Fadi S. Althobaiti, Saud Y. Alsharif, Muhannad A. Alhazmi, Abdullah H. BinMelieh, Abdulaziz A. Almqaiti, Ziyad K. Alsaedi, Amal M. Alkhotani, Bassam G. Sef
Neurosciences Journal Apr 2025, 30 (2) 131-137; DOI: 10.17712/nsj.2025.2.20240098

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Thunderclap headache management among Emergency Department visitors in tertiary care center in Makkah City: Retrospective cohort study
Fadi S. Althobaiti, Saud Y. Alsharif, Muhannad A. Alhazmi, Abdullah H. BinMelieh, Abdulaziz A. Almqaiti, Ziyad K. Alsaedi, Amal M. Alkhotani, Bassam G. Sef
Neurosciences Journal Apr 2025, 30 (2) 131-137; DOI: 10.17712/nsj.2025.2.20240098
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