title: Sentinel headache and the risk of rebleeding after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  The clinical significance of sentinel headaches in patients with subarachnoid hemorrhage (SAH) is still unknown. We investigated whether patients with a sentinel headache (SH) have a higher rate of rebleeding after SAH.
  
  
  METHODS
  An SH was defined as a sudden, severe, unknown headache lasting >1 hour with or without accompanying symptoms, not leading to a diagnosis of SAH in the 4 weeks before the index SAH. Age, sex, smoking status, clinical grade, computed tomography (CT) findings, angiographic findings, placement of an external ventricular drain, and time to aneurysm obliteration were prospectively recorded. All rebleeding events were confirmed by CT. Outcome was assessed at 6 months according to the modified Rankin Scale.
  
  
  RESULTS
  Of 237 consecutive patients with SAH, 41 (17.3%) had an SH. Rebleeding occurred in 23 (9.7%) of all patients. Patients with an SH had a 10-fold increased odds of rebleeding compared with patients without SH. Aneurysm size and the total number of aneurysms were also significantly associated with rebleeding. There were no differences in age, sex, smoking, CT or angiographic findings, external ventricular drain placement, or time to aneurysm obliteration between groups. Patients with rebeeding had a significantly worse outcome. Logistic regression revealed the presence of an SH as an independent risk factor for rebleeding.
  
  
  CONCLUSIONS
  In our study, patients with SAH who had an SH constituted a special group of patients with a 10-fold odds for early rebleeding. The presence of an SH may select candidates for ultraearly aneurysm obliteration or drug treatment.
authors.affiliation: Department of Neurosurgery, Institute of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. J.Beck@em.uni-frankfurt.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.forename: Andrea
authors.initials: A
authors.lastname: Szelenyi
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Gerlach
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control