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

Objectives: To evaluate adherence to the guidelines in managing thunderclap headache (TCH) at King Abdullah Medical City Specialist Hospital (KAMC) in Makkah. A thunderclap headache, a severe and sudden onset headache, often signals a subarachnoid hemorrhage (SAH). The International Classification of Headache Disorders, 3rd edition (ICHD-3), recommends a diagnostic approach for TCH, including computed tomography (CT), lumbar puncture (LP), vascular studies, and magnetic resonance imagining (MRI).

Methods: This retrospective cohort study included adult patients presenting with TCH, as defined by ICHD-3, from December 2018 to June 2023. Non-probability convenience sampling was used to select patients.

Results: Of 377 initial records, 173 patients met the inclusion criteria. The mean age was 52.6 years, with males comprising 57.2%. Hypertension (39.9%) and diabetes mellitus (20.2%) were common comorbidities. Key clinical features included nausea/vomiting (41.0%) and loss of consciousness (27.7%). Compliance with ICHD-3 guidelines was 96.5%, with 99.3% undergoing CT within 6 hours. Most patients (91.3%) were diagnosed with hemorrhagic conditions, primarily SAH (85.5%), with a recovery rate of 89.2%. However, 8.1% of patients died, primarily due to complications like rebleeding and infection.

Conclusion: High adherence to ICHD-3 guidelines in TCH management led to favorable outcomes, demonstrating the effectiveness of systematic evaluation. The study highlights the importance of timely intervention and suggests that demographic factors may not significantly influence TCH outcomes. Further research should explore guideline adherence in varied settings.