Headache in Cerebral Venous Thrombosis
Objectives: Although headache is the most frequent and often the earliest symptom of cerebral venous thrombosis (CVT), few studies have attempted to define its clinical features. Our aim is to describe the main characteristics of headache in CVT patients. Methods: From March 1996 to June 2000 we prospectively evaluated 39 patients. After clinical examination, diagnostic confirmation was obtained by magnetic resonance imaging and/or angiography. Information about headache was recorded on a standardized form, including location, severity, duration, quality, worsening and associated features. Results: The group included 69% females (mean age 35 years; range 8–81). Headache occurred in 35 patients (89.7%), and was the initial symptom in 84.6%. In 28.6% an isolated intracranial hypertension syndrome occurred. Among 66 % with severe headaches, 70% had multiple sinus thrombosis and 43.4% had intraparenchymal lesions. Four patients (11.4%) had a thunderclap-like headache. Headache onset was acute (< 48 hours) in 9 patients (26%), subacute (48 hours to 30 days) in 7 (20%) and chronic (> 30 days) in the remaining 54%. Headache was mostly focal (63%) and pulsatile in 48.6% patients. Pain worsened with head movements in 31.4% of patients, physical activity in 23% and coughing or sneezing in 20%. The most striking feature was the presence of focal signs (aphasia, motor and sensory deficits and visual field defects) in 74% of patients. In 11 of the 23 patients with severe headache, mean initial CSF pressure was 37.6 cmH2O and in those with thunderclap headache it was 51.7 cmH2O. Prior history of headache was present in 17 of CVT patients (48.6%). Conclusions: Headache was a frequent symptom, usually severe and focal at onset in our CVT patients. The severity of headache seems to be associated with initial CSF pressures, however, a clear relationship with intraparenchymal lesions was not observed. A striking feature was the association of headache and other neurological abnormalities. Thunderclap headache is seldom considered in patients with CVT. Prior headache was frequent and may contribute to diagnostic delays. The recognition of headache characteristics may help earlier identification of CVT patients in the emergency room.